Oral Answers to Questions

SCOTLAND

The Secretary of State was asked—

Scottish Elections

John Robertson: What discussions he has had with the First Minister on the measures required to ensure maximum voter participation in the Scottish Parliamentary and local council elections in May 2007; and if he will make a statement.

David Cairns: The Government and the Scottish Executive are working closely together to ensure maximum participation in the combined elections on 3 May.

John Robertson: As my hon. Friend knows, leaders of all the major political parties have urged a high turnout in the May elections. Will he redouble his efforts and, in particular, seek the help of the media to explain to their readers and viewers why it is so important that they turn out on 3 May to ensure that they get the Government they deserve?

David Cairns: My hon. Friend raises an important matter. The upcoming elections are vital for Scotland's future, and I hope that in the run-up to the elections the key issues at stake will be given a good airing in the media. At stake are two different visions of Scotland. One is of a confident Scotland playing a full role in the United Kingdom, continuing to invest in schools and in skills, and continuing to address the big challenges that face our country in the 21st century. The other vision of Scotland's future is one mired in years of constitutional wrangling, with uncertainty about what our currency will be and who will set the monetary framework, with Scotland isolated from our key allies, out of the European Union and completely irrelevant. It is a big election and there are big issues at stake.

Angus Robertson: The Minister knows that in normal democracies, debates play a major part in encouraging turnout of voters. The Secretary of State for Scotland regularly appears on television debates instead of the First Minister, who seems unwilling or unable to take part. Will he encourage Jack McConnell to stop running away and take part, at least between police interviews?

David Cairns: The hon. Gentleman's leader had the opportunity to be in the Scottish Parliament and debate with Jack McConnell every day of the year, but he chose to run away from the Scottish Parliament to come here to lead a rump group. Now he wants to go back, but he wants to stay as an MP here. He wants to be a Member of the Scottish Parliament for a constituency and he wants to be on the list. The elections are not just about debates on television. They are about real, substantive issues, a vision of a Scotland that would be isolated under him, which would not have its own currency, which would not set its own monetary policy framework, and which would be isolated in Europe because his party would take us out of the European Union. His party has no clue how to address the great big challenges facing Scotland today. That is why, once again, as in every single election, it will be rejected by the Scottish voters.

James McGovern: One of my concerns about the upcoming Scottish elections is that many of the migrants from various parts of the European Union working in Scotland may not be aware of their right to vote and the need to register to vote. What discussions has my hon. Friend had with the Scottish Executive to ensure full participation for all those legally living, working and paying taxes in Scotland?

David Cairns: My hon. Friend raises an important issue. When we passed the Electoral Administration Act 2006, there was great concern about how we would make sure that the new migrants in the country from Poland and elsewhere in the EU who are entitled to vote in these elections would be made aware of the fact that they could vote and would be encouraged to be put on the electoral register. That is why we have given additional financial support to electoral registration officers to drive up registration and to put out information in other languages, including Polish, so that all those who are living in Scotland and making a financial contribution to Scotland, and who are entitled to vote in the elections, get the opportunity to do so.

David Mundell: The Scottish Executive and the Scotland Office published their response to the Arbuthnott Commission today. I find both responses disappointing. Does the Minister share my consternation that the Scottish Executive should dismiss the Arbuthnott Commission's recommendation to split the Scottish parliamentary and local government elections, without presenting any evidence that that would increase turnout, whereas all the evidence shows that it will increase confusion? Does he agree that the Scottish Executive and his Government are showing contempt for the people of Scotland by bringing about two major electoral changes on one day?

David Cairns: I am disappointed that the hon. Gentleman is disappointed. We have taken one of the key recommendations from the Arbuthnott report to combine the ballot papers in the Scottish Parliament elections, so that Scottish voters are not presented with one ballot paper for the first-past-the-post constituency and another for the regional list, which did generate some confusion. We have worked hard with the Electoral Commission and others to produce a design that would be colour coded and make things as simple as possible when people cast their vote. The decision on the date of the local elections is entirely a matter for the Scottish Executive, but I share their view that combining the elections on the same day will help turnout.

David Mundell: Does the Minister accept that voter participation is not just about the number of people who turn up at the polling station but the number of validly cast votes? What level of improperly cast ballots is unacceptable? Will he and the Scottish Executive move away from the system that they, along with their Liberal Democrat chums, foisted on the people of Scotland?

David Cairns: It is important to distinguish between a genuine mistake when filling in a ballot paper and voter fraud, to which I believe that the hon. Gentleman refers. There is no evidence of significant voter fraud in Scotland. If he has any, he should present it. We included provisions in the Electoral Administration Act 2006 to combat voter fraud. I remind him that he spent a large part of his career as a member of the Social Democratic party, which promoted the single transferable vote system.

Katy Clark: Does my hon. Friend agree that, given the new electoral system for the local government elections in Scotland, we should do everything we can to ensure that it is publicised as widely as possible so that we get the maximum possible turnout?

David Cairns: I agree. The Electoral Commission has a key role to play in that. It recently made three significant grants available to: the Leonard Cheshire foundation, which helps ensure that people with disabilities can vote; Outside the Box, which helps those with learning disabilities, and the Council of Ethnic Minority Voluntary Sector Organisations. We want to ensure that everyone in Scotland, regardless of creed, colour and disability, can participate in the elections. It is also important that Members of Parliament do our bit to ensure that as many people as possible are registered to vote. We must encourage our councils and electoral registration officers to undertake that. We have a clear vision: everyone who is entitled to vote must be allowed to do so, and there must be minimum fraud and the highest possible turnout.

Jo Swinson: There is concern in all parties about low turnout among young people in elections. Next May, for the first time in Scotland, 18-year-old candidates, including the Liberal Democrat challenger in the First Minister's constituency, will stand for election. I hope that the Minister and the First Minister welcome the implementation of that new law. When will the Government take the next step and encourage more young people to play an active part in the political process by introducing voting at 16?

David Cairns: First, the hon. Lady could have said that it is a reform introduced by the Government that allows 18-year-olds to stand as candidates. That provision did not fall out of a clear blue sky. It underlines our commitment to engaging with young people and ensuring that they play a full part.
	The Electoral Commission has done a great deal of work on voting at 16. Opinion is evenly divided about whether that is a good idea even among 16 and 17-year-olds. I am not especially attracted to the proposal, but we can keep an open mind on it. I stress that, for young people, the vision of Scotland that invests in them, their future and education and skills will contrast with a vision of Scotland that mires us in years of constitutional argument so that, in the meantime, any business thinking of investing in the United Kingdom will not choose Scotland. That is not a good future for young people.

Jim Sheridan: Does my hon. Friend agree that the best way in which to encourage people to get involved in the democratic process is to demonstrate the importance of politics and how it enhances the quality of their lives? I am sure that he will take every opportunity to remind the electorate of what the Scottish Labour Government have done for the people of Scotland.

David Cairns: I certainly will. I shall specifically consider the performance of the Scottish education system, which has long been acknowledged to be excellent. Thanks to our additional investment in schools, and the strength of the UK economy, which has allowed the Scottish Executive to increase investment in schools massively, we have even better results. We now need to move forward to consider, for example, skills and skills academies, which will be to the fore on Labour's agenda for the future of Scotland. We have an optimistic vision for that future, in which young people will be encouraged to stay and play a full part.

Correspondence

Peter Bone: What average length of time it has taken for a reply to be received to correspondence from him to the First Minister.

David Cairns: On average, correspondence from the First Minister to the Secretary of State for Scotland has been sent within the 20-day target time scale set by the Scottish Executive.

Peter Bone: That is a most illuminating answer. On 6 November 2006, I wrote to the First Minister to ask how many people waited more than six months for a national health service operation, in breach of the Government's guarantee. I appreciate that the question might be embarrassing for the First Minister, but, despite a chasing letter, I have yet to receive a reply. Is not that shameful?

David Cairns: I understand that the Health Minister in the Scottish Executive has written a reply to the hon. Gentleman, in which he apologises for the delay in responding to him. He also points out that waiting times and waiting lists in Scotland are falling, that the number of patients with a guarantee waiting more than 18 weeks is the lowest ever recorded, and that deaths from cardiac disease, cancer and stroke are all falling after years of increasing. Those things have not happened by accident. They have happened because the UK Government made available to the Scottish Executive record sums of money to invest in the health service, yet the hon. Gentleman voted against every penny—

Mr. Speaker: Order.

Pete Wishart: Is it not the case that the Scotland Office has sent a pitiful 350 official letters since 2005, while receiving, on average, seven letters a day from a concerned and anxious public? Does the Minister think that that represents good value for money? Will he explain what exactly is the point of the Scotland Office, given this overwhelmingly burdensome activity?

David Cairns: Given that some of those letters are from the hon. Gentleman and his hon. Friends, he is adding to the enormous burden of work that the Scotland Office has to do. All appearances to the contrary, the Scotland Office is a remarkably slim and lean organisation. If the hon. Gentleman looks across Whitehall and across the devolved Administrations, he will see in the Scotland Office a highly efficient organisation that carries out its activities in a very efficient way.

Gas Production

Robert Smith: What discussions he has had with ministerial colleagues on the benefits to Scotland of encouraging gas production west of Shetland.

Douglas Alexander: I have regular discussions with ministerial colleagues on a range of issues. As my right hon. Friend the Secretary of State for Trade and Industry confirmed to the hon. Gentleman last week, the lack of gas infrastructure west of Shetland is a key constraint on present development. We have established a group from industry and Government to work together on that. In addition, we have changed the licensing scheme to encourage development. About 60 blocks have been licensed, and activity is under way.

Robert Smith: I thank the Secretary of State for that answer. The whole country benefits from developments in the North sea, and the Scotland Office should be well placed to impress upon the Government just how much high-tech industry and how many manufacturing jobs are developed on the back of such activity, and exactly what the export potential is. It is crucial to find new provinces and to open up new fields before we decommission the old ones. In his answer to me last week, the Secretary of State for Trade and Industry spoke a lot about the problems of getting the oil out, but the crucial factor in the west of Shetland basin is the need to get the gas fields together. It is the cost of bringing together the small gas fields that is inhibiting production.

Douglas Alexander: I am certainly happy to reiterate the hon. Gentleman's points to my right hon. Friend the Secretary of State for Trade and Industry. The hon. Gentleman is right to acknowledge the significant potential west of Shetland. It represents about 17 per cent. of the UK's remaining oil and gas reserves, and presents a considerable challenge, on which the Government are working with industry.

Gordon Banks: While such exploration is important, does my right hon. Friend agree that an economy built solely on the success or failure of fossil fuels is likely to result in an overall reduction in spending and economic activity?

Douglas Alexander: My hon. Friend is right to say that oil in the North sea and elsewhere is a finite commodity. North sea production passed its peak in the first year of the Scottish Parliament back in 1999.

Angus MacNeil: Ask the Norweigans.

Douglas Alexander: I hear the claim that Norway should be a lodestar for us in using that finite commodity more effectively. Norway has about twice the UK's oil reserves, yet Norwegians pay a higher top rate of tax, a higher basic rate of income tax, higher VAT, higher employers' national insurance contributions and higher duties. That is something that the whole House should consider.

Immigration

Philip Hollobone: What recent discussions he has had with European commissioners on immigration into Scotland.

David Cairns: My right hon. Friend the Secretary of State and I have regular discussions regarding immigration matters, but we have had no discussions on those issues with the European Commissioners.

Philip Hollobone: How many immigrants from the new EU entrant states have arrived in Scotland since the accession of those countries, and how many work permits does the Secretary of State expect to issue to immigrants from Bulgaria and Romania?

David Cairns: I do not have those figures here, but I am happy to write to the hon. Gentleman with them. Scotland and the Scottish economy have benefited from the inward migration of people from the accession states. Scotland has near record low levels of unemployment and near record high levels of economic activity. That situation never occurred during the 18 years when the hon. Gentleman's party was responsible for the economy.

Michael Connarty: When my hon. Friend does meet the Commissioners to discuss immigration, will he emphasise the tremendous benefits that we have gained from the immigrants who have come to work in Scotland from the EU accession states? Will he also raise with them the need for a speedy implementation of the temporary workers directive, because it is clear that, in some parts of Scotland and elsewhere, the people who are coming in are being forced to work under certain conditions because they are in gangs? They are not getting proper holiday pay, sickness pay or pension benefits. The only way to ensure that such people are not exploited is to have the same rules for everyone, so that every temporary worker and everyone coming in from elsewhere in the EU works under the same conditions as UK employees.

David Cairns: My hon. Friend is right to point out the economic contribution that individuals from the A8 countries are making in Scotland. They are entitled to the same employment protection as everyone else, including rights to the minimum wage. It is important that those workers receive the minimum wage and are not used to undercut wage rates throughout Scotland. He mentioned the issue of gangs, and he is sitting beside our hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) who, through his gangmaster legislation, has done more than anyone else to highlight the issue, for which I pay tribute to him. It is absolutely right that people coming into this country are treated fairly and on a level playing field with everyone else.

Alex Salmond: How would the Secretary of State find time to meet European Commissioners when he is so busy standing in for the First Minister in debates on Scotland. Has not the reality of Scotland's European representation been laid bare by the leaked memo from the head of the European office of the Scottish Executive, which says that UK Departments ignore Scottish representations, that Scottish Ministers have to wait outside the Council of Ministers while decisions are made and that,
	"Scotland no longer has a hard-hitting voice within Cabinet"?
	Is that a reference to the Secretary of State, or just to the reduced status of his office?

David Cairns: I am delighted that the hon. Gentleman has raised the issue of that report, which gives me the opportunity to read out its conclusion— [Interruption.] He would do well to listen to this. It states:
	"Scotland's voice in Europe is stronger as part of the UK. As one of the big 4 Member States within the EU, the UK is a very powerful player. There is no more effective a position for Scotland than having one of the most influential Member States representing Scotland's interests within all 3 of the EU institutions."
	His argument is completely demolished.

David Mundell: For once I can agree with the Minister. Can he shed a little light on the lack of clarity in relation to the future role of European Commissioners in respect of immigration and all other issues in Scotland if it were torn out of the United Kingdom, and if it had to reapply, as it surely would, for EU membership?

David Cairns: It is entirely clear that if Scotland were to secede from the member state country, it would secede from the European Union, and would have to reapply. The French have recently altered their constitution to show that Scotland would not be allowed back in the EU unless there was a yes vote in a referendum in France. We would therefore be handing over Scotland's future membership of the EU to the French electorate. Even were that not the case, the hon. Member for Banff and Buchan (Mr. Salmond) proposes to take Scotland out of the common fisheries policy, which means that he would not even be at the Fisheries Council to take part in such discussions. Twenty-five countries would be debating the common fisheries policy in one room, and he would be in the next room, talking to himself. I know that he is never happier than when talking to himself, but that will do Scotland no good at all.

Military Bases (Security)

Sandra Osborne: What recent discussions he has had with the Secretary of State for Defence on security at military bases in Scotland.

Douglas Alexander: I have regular discussions with my right hon. Friend the Secretary of State for Defence on a number of issues.

Sandra Osborne: Scotland has a proud tradition of peaceful protests, and I have taken part in many for causes in which I believe, not with the sole purpose of getting arrested for a cheap photo opportunity. Does the Secretary of State agree that the recent irresponsible conduct of some MSPs, who say that they aspire to run our country, has been not only a waste of police time but has deprived some of our poorest communities of the increased police presence that they richly deserve?

Douglas Alexander: I recognise, as does my hon. Friend, the right to peaceful protest. Those elected representatives who organised some kind of pantomime arrest at Faslane should answer to their constituents as to whether they regard that as a good use of police time when we face challenges such as antisocial behaviour, and not least when the police have been given new powers to deal with such issues, notwithstanding the opposition of some parties represented in this Chamber.

Willie Rennie: Has the Secretary of State had discussions with the Ministry of Defence about the so-called Trident tax and its possible effects on the MOD budget and therefore on security in military bases in Scotland?  [Interruption.] If so, did he consider whether the tax might be illegal, and whether it was in fact pointless to impose any tax, because any taxes collected would result in cuts in the Scottish Executive budget in the long run?  [Interruption.]

Mr. Speaker: Order. I must tell members of the Scottish National party that it is only courteous to allow hon. Members to be heard in the Chamber. That also applies when Ministers are replying.  [Interruption.] I am trying to put the case against intervening, and there is the hon. Member for North-West Leicestershire (David Taylor) opening his mouth. That does not help.

Douglas Alexander: The story that appeared in the Scottish newspapers at the weekend about the so-called "tax on the taxpayer" tells us far more about Opposition parties' desperate need for headlines than about any serious attempt at policy-making. Once again we have a party that, while professing to want independence in Europe, seems intent on ignoring European Union law.

Green Energy Generation

Shailesh Vara: What steps are being taken to expand the use of green energy generation from wave and tidal sources in Scotland.

Douglas Alexander: Since 1999 the Government have committed £29 million to the research and development of marine energy technologies. In addition, we have created the marine renewable deployment fund with a further £50 million allocated to help projects move from the research stage to demonstration. Moreover, we have invested in infrastructure. That investment includes £15 million for the European Marine Energy Centre in Orkney, a dedicated test facility for wave and tidal technology developers.

Shailesh Vara: Given the Government's intention to introduce a climate change Bill, has the Secretary of State considered the impact that the Bill will have on the Scottish Executive's approach to the environment?

Douglas Alexander: In the normal course of events, we discuss such matters with the Scottish Executive. However, it is entirely consistent to recognise in statute—as the Bill will—the considerable change described in the Stern report and other academic studies of the science of climate change.
	I pay tribute to the labour-led Executive in Scotland. They have taken a pioneering role, particularly in relation to renewables, and recognise not just the challenge but the responsibility to develop such technologies in the years ahead.

John Thurso: The Secretary of State will be aware of the immense potential for tidal energy in the Pentland firth and, indeed, other remoter areas off the coast of Scotland. Is he also aware that one of the potential barriers is the lack of transmission capacity? Does he agree with the many experts who now believe that an undersea interconnector would be a more effective way of reducing the lack of transmission than pylons?

Douglas Alexander: A number of technical challenges will need to be overcome in what is still, at this stage, a relatively immature technology. The main challenge is to move that technology forward. I assure the hon. Gentleman that all such matters are given due consideration. They have been dealt with in discussions that I understand he has had with my hon. Friend the Under-Secretary of State, and also in other discussions that take place in Government, particularly with the Department of Trade and Industry.

Michael Weir: Would not the most important help be not requiring energy producers to pay £20 per kWh to connect to the national grid, as opposed to the subsidy of £8 per kWh that is provided in London?

Douglas Alexander: The suggestion that greater connections to the English market somehow make sense is certainly an interesting line of argument coming from a nationalist, given that the nationalists seem intent on putting up new barriers.

Asylum Seekers

Alistair Carmichael: What recent discussions he has had with Home Office Ministers on dawn raids to remove failed asylum seekers in Scotland.

David Cairns: My right hon. Friend the Secretary of State and I have regular discussions with Home Office Ministers on matters that affect Scotland.

Alistair Carmichael: When the Minister next meets the Minister responsible for immigration, will he convey to him the revulsion that is widely felt in Scotland at the practice of dawn raids, especially when children are involved? It is now matched by the revulsion at a new practice involving the luring of children and whole families to immigration offices for signing-on purposes.
	If the Minister will not listen to the people of Scotland, will he listen to the United Nations Refugee Agency, the United Nations High Commissioner for Human Rights, Amnesty International and the Commissioner for Children and Young People in Scotland? They all deplore the practice as well.

David Cairns: Absolutely no one wants early-morning removals to continue. They can only ever be justified as a last resort, when families and individuals have been invited to leave over and over again, when they have been offered financial assistance to leave over and over again, and when they have refused to leave over and over again. If we are to have an immigration and asylum policy that has any meaning at all, we must reserve the right as a nation to say no to some people, and if they refuse to go we must reserve the right to remove them by force if necessary. I do not want to see that happen. I want to see a situation, which we will have under the new asylum model, where decisions are made much more quickly, one caseworker works with individuals throughout their case, and individuals, when they have exhausted their appeals and are invited to leave the country, actually leave.

COMMUNITIES AND LOCAL GOVERNMENT

The Secretary of State was asked—

Lyons Review

Chris Mole: What assessment she has made of the implications for the local government White Paper of Sir Michael Lyons review.

Phil Woolas: The pre-Budget report stated that Sir Michael's report would be published around the time of the Budget 2007. In developing the White Paper, the Government took full account of his work to date on the future role and function of local government. That included in particular his discussion paper on the future role and function of local government, national prosperity, local choice and civic engagement, which was published in May last year.

Chris Mole: May I thank my hon. Friend for his response and ask him to confirm that, while Sir Michael Lyons is due to report in March and further legislation may be required at that time, it is the Government's current intention, on the back of the White Paper, to increase the amount of funding that councils receive that is not ring-fenced? Will the Minister confirm that he will increase the sums pooled in local area agreements?

Phil Woolas: I thank my hon. Friend for that important question, which gives me the opportunity to confirm that that is the case. The Government's policy is to have a presumption against ring-fencing in funding. May I tell the House through you, Mr. Speaker, that this year the local area agreements will receive £520 million of pooled money and that that will rise to up to £1.5 billion in the financial year 2007-08, so I can confirm that the answer to the question is yes.

Mark Pritchard: When the Government report on that White Paper, will they include a new local business tax?

Phil Woolas: I think that the hon. Gentleman is referring to Sir Michael Lyons report rather than the White Paper. I appreciate the importance of his question. The answer to that question is that neither I nor the Government know what Sir Michael is going to report on that matter. Of course the distribution of non-domestic rates is a hugely important part of local government funding, contributing around £17.5 billion this year, so we await his report with interest.

Clive Betts: I am sure that my hon. Friend will agree that if Sir Michael's report is to be a success, it will have to find ways of ensuring that local authorities can raise more of the money that they spend. It is also important that it finds a way of dealing with the perversity of gearing in local government finance, and a way of giving local authorities incentives to consider favourably planning applications for business and commercial developments. Is not the easiest way to do that simply to denationalise the business rate and to give control of the rate back to local authorities?

Phil Woolas: I am aware of my hon. Friend's long-standing advocacy of that point. I note that he said it was the easiest way; he did not say that it was easy. It would be best if I were not drawn on that matter. Suffice it to say that the Government have introduced the local authority business growth incentives scheme that incentivises and rewards local authorities that achieve a growth in the number of businesses created, or indeed a slowdown if it is in a negative area. That scheme will be distributing some £1.5 billion. That is real money from which local authorities are benefiting.

Caroline Spelman: Last night, the Minister said that the Lyons' review had to be delayed until after the Local Government and Public Involvement in Health Bill to deal with form and function first, but after the publication of the Lyons interim review Sir Michael made it clear that he had views about devolution and fewer targets, and he warned against another massive restructuring, so what is it in the Lyons review that the Government are trying to hide?

Phil Woolas: I was as confused by that question as I was by the hon. Lady's contribution to last night's debate. I repeat what I said: it makes perfect sense—to me it is common sense, and I think that the Opposition are trying to find ways to oppose for the sake of opposing—to have the White Paper and the Bill on local government functions before looking at financial proposals and any legislation that might be produced, because if that is required, it will have to be introduced in the next parliamentary Session.

Caroline Spelman: In his report of last May, Sir Michael Lyons clearly stated his views about political boundaries being redrawn. That has nothing to do with finance, but everything to do with form and function. In the interests of common sense, will the Government now give an assurance that Sir Michael will be asked to give evidence to the Bill Committee, as requested?

Phil Woolas: I cannot give that guarantee. With respect, I think that the hon. Lady is rather confused about what her own policy is. The Opposition have asked for a permissive regime that would allow local authorities to put forward proposals for restructuring, where they wish to do so. The deadline for initial proposals is the end of the current week, and I suspect that there will be proposals from local authorities of all types and all political colours from across the country. Some of them will be Conservative and some will not, and I await all the proposals with interest.

Neil Turner: Central and local government have an agreed formula to distribute grant to local authorities. Not all councils receive the grant that that formula dictates. Can the Minister give an assurance that at the end of the next comprehensive spending review all councils will receive the agreed level of grant?

Phil Woolas: No, I cannot guarantee that. My hon. Friend again raises that important point on behalf of his four-star council. To be fair, it is a point that has been raised by Members of various parties. It concerns authorities that would receive more money if the Government had not put in a floor to protect those authorities that would lose significant amounts quickly if we had not put in that damping effect. The Government's position is that we retain damping to protect those authorities, but as we move into the next financial settlement, which will be for a three-year period from April 2008 onwards, we will review decisions in the light of that important announcement.

Andrew Stunell: The Minister has just repeated what he said in yesterday's debate, which is that he thinks that it is an advantage to Members that we are considering his Bill prior to the Lyons report. It is my understanding that that view is not shared by Sir Michael himself, nor by many in the local government family who find it astonishing that we are being expected to take one set of decisions without being aware of what the Government intend to do in respect of another set. Can the Minister say exactly what he thinks the advantage is in our dealing with the Bill in the dark without the Lyons report; and can he give us an assurance that when the Lyons report is published he will take quick action to abolish the council tax and to repatriate the uniform business rate to local councils?

Phil Woolas: I strongly advise the hon. Gentleman who speaks for the Liberal Democrats seriously to revise his policy on business rates. At present, £17.5 billion is redistributed through the non-domestic rating system, as opposed to £3.335 billion through the remainder of the revenue support grant—RSG. Of that £17.5 billion, some four or five councils contribute almost 10 per cent. The redistributive effect of the national non-domestic rates—NNDR—in the absence of the dedicated schools budget from the RSG renders his policy one that would significantly damage the poorer areas of this country. Therefore I cannot give him the guarantee that he asks for.

Andrew Gwynne: When considering the Lyons review findings, can my hon. Friend look at better developing ways to ensure that those—sometimes not insubstantial—areas of the country that have pockets of deprivation and real need but which are located in local authorities that are considered to be affluent do not miss out on the additional funding that they need and deserve?

Phil Woolas: I commend my hon. Friend for raising again a problem that one of the local authorities in his constituency faces. Members of different parties point to wards or sub-ward areas that have poverty and deprivation that are not recognised in either the neighbourhood renewal fund or, it is argued, the RSG—although it is, of course, weighted within the RSG. I cannot give my hon. Friend the commitment that such changes will be made in the current financial period, but I do give the commitment that I will look at it for the future spending review period.

Travellers (Crays Hill)

John Baron: What recent assessment she has made of the Traveller situation in Dale Farm, Crays Hill.

Meg Munn: The Secretary of State is considering a number of planning appeals in relation to Dale Farm. As this case is under active consideration, and for reasons of procedural propriety, it is not possible to comment on its details. A decision is expected by 28 February.

John Baron: I thank the Minister for that answer, but she will be aware of recently published research by the Echo newspaper that casts doubt on claims by Travellers at Dale Farm that they have nowhere else to go, should the pending inquiry decision go against them. On Thursday, representatives from the settled community will visit Parliament to press for this research to be considered before the Government's decision, and for a Government-led inquiry into the issue in general. In the interests of fairness, will the Minister consider meeting this delegation, as we know that the Department has had contact with Travellers from Crays Hill?

Meg Munn: There have been no meetings between the Department's Ministers and Travellers concerning this application. For reasons of propriety, it is not appropriate for Ministers to meet any of the parties while this matter is under consideration, as the hon. Gentleman well knows. So this is not a question of Ministers not wanting to take the full range of issues into consideration; this is a procedural point, and he serves his constituents ill by suggesting that we can do otherwise.

Several hon. Members: rose—

Mr. Speaker: Order. This is a very narrow question that relates only to Travellers from Dale Farm, Crays Hill. We must move on.

Community Land Trusts

Jim Cunningham: What assessment her Department has made of the role of community land trusts in affordable housing projects.

Ruth Kelly: Community land trusts are an interesting and promising new option for delivering affordable housing. The Housing Corporation and English Partnerships are working with a number of potential community land trusts, with the aim of getting some viable pilot schemes established.

Jim Cunningham: I thank my right hon. Friend for that answer. Has she assessed the value of these projects and what the resource costs might be?

Ruth Kelly: I thank my hon. Friend for his question and he is absolutely right to say that we need to look at the evidence to see how these projects can contribute to our affordable housing targets, and whether tenants should be able to have a greater say over their own estates and housing developments, and what difference that would make. That is precisely why the Housing Corporation and English Partnerships are working with a number of potential projects to help them get up and running. They hope to have a number up and running by this summer, and some on site by the end of next year.

Brian Binley: Supplementary planning gain, or, to use its proper name, a roof tax, will certainly make land scarcer and more expensive. How does the Secretary of State equate the need to build more affordable housing, which I accept, with that tax?

Ruth Kelly: The hon. Gentleman knows that we have the Planning-gain Supplement (Preparations) Bill in place, so that we can consider all the issues in detail. Frankly, our proposals, which look seriously at the need for more infrastructure provision and the need to finance it, are far more credible than the position adopted by the Conservatives, who have no proposals whatsoever for funding greater infrastructure.

Brian Iddon: Does my right hon. Friend know that the northern housing forum recently met the Minister for Housing and Planning, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), to suggest that land already in council ownership should be allowed to be released at nil, or below market, value, so that houses affordable to ordinary people could be built on it?

Ruth Kelly: I am aware of the meeting that has recently taken place between Bolton At Home and my hon. Friend the Minister for Housing and Planning, and I know that this was one of the issues considered at that meeting. It has come up with an incredibly interesting and innovative proposal to use local authority land so that people have much greater access to low-cost home ownership. I understand that that bid is in with the Northern Housing Challenge and will be considered, and I hope that a shortlist will be announced soon.

Michael Gove: I am grateful to the Secretary of State for her warm words about community land trusts and will take them as an implicit endorsement of our policy to use them as a way of increasing housing supply and aiding low cost home ownership. I am sure that she will be aware that the Scottish community land unit provides pre-development support for those who wish to set up CLTs and has access to money from the Big Lottery Fund. We are all aware that Scottish expertise will be playing a bigger part in the Labour party in the months to come, so can the Secretary of State assure me that she will pre-empt that move by learning from Scotland and making money available from the Big Lottery Fund for those in England and Wales who wish to access low-cost home ownership through CLTs?

Ruth Kelly: May I say how wholeheartedly I welcome the hon. Gentleman's commitment to look at all sources of funding and, indeed, land for new affordable housing. Indeed, we will look at any option that he or anyone else puts forward to increase the supply of land for that purpose. I read recently of the hon. Gentleman's claim that his new-found interest in community land trusts was inspired by the Levellers of the English civil war. I am rather more interested in the current civil war in the Conservative party on whether to build new homes for affordable housing. Indeed, only last month the hon. Gentleman said, "I think"—

Mr. Speaker: Order. I must stop the right hon. Lady there.

Council Housing

Lynda Waltho: If she will provide further funding to improve council housing.

Paul Rowen: What progress has been made towards achieving the decent homes standard.

Yvette Cooper: Yes, we will provide further funding for improving council housing. So far the decent homes programme has cut the number of homes failing the decency standard by some 1.4 million and has delivered 720,000 new boilers and central heating systems for council and social housing across the country.

Lynda Waltho: While I recognise the Government's focus on that particular policy and the increased investment, my surgeries are still inundated with residents who want to move to better properties, people desperate for homes, and others who want simple things such as central heating or some repairs. What help or hope can my hon. Friend offer to my constituents?

Yvette Cooper: My hon. Friend raises an important point. We have said that all council and social housing needs to meet the decency standards. It is shocking that we inherited a £19 billion backlog in repairs and maintenance in 1997. We will, by 2010, have invested £40 billion in improving those homes, including putting in modern kitchens and central heating, tackling fuel poverty and cutting carbon emissions from those homes.

Paul Rowen: I appreciate the Minister's comments about council housing and the social rented sector in general. However, part of the commitment made in the decent homes charter was to private sector vulnerable households. I am aware that in Rochdale, for example, 66 per cent. of all private sector vulnerable households are unfit, largely because of thermal comfort issues. In view of the fact that across the north-west last year 303 old people died of hypothermia, what further action will the Department take to deal with private sector vulnerable households?

Yvette Cooper: The hon. Gentleman raises an important point. I know that the arm's length management organisation in Rochdale has almost completed its programme and, thanks to the £100 million provided by the Labour Government, will have refurbished and modernised more than 16,000 homes in the area, ensuring that they meet the proper standards for central heating and insulation. The hon. Gentleman is right to say that we need to support private sector homes to ensure that pensioners in particular are not living in cold homes. The warm front programme has already assisted 1.2 million households across the country and we want to go further in helping to warm and insulate more such households.

David Taylor: Of course the Government deserve congratulations for tackling the enormous backlog of repairs and improvements that they inherited in 1997, but could we not go further, with an additional source of funds, and stop the process by which good local authority landlords, who have long provided decent, affordable housing in an accountable framework, are coercing tenants into stock transfers that they do not want, employing consultants and spending many millions of pounds on a process that is utterly wasteful?

Yvette Cooper: We have provided additional funding to councils so that they can refurbish their homes, and it amounts to a 30 per cent. increase per home since 1997. Using that additional funding and their own resources, nearly 100 councils will be able to bring their stock up to the decency standard over the next few years. The additional funding has been provided through the ALMO programme and stock transfers and is a very substantial investment in existing homes, but my hon. Friend will accept that we must make sure that there is investment in building new homes, for which there is also a serious need.

Stewart Jackson: One consequence of the Government's mismanagement of EU migration is the great strain placed on social and private sector housing in some parts of the country. What are the Government going to do about the exploitation of EU migrants by unscrupulous landlords? Also, the poor condition of many houses in multiple occupation is a major problem in places such as Peterborough, where we have 6,500 people on the council waiting list. What are the Government going to do about that?

Yvette Cooper: I am sure that the hon. Gentleman welcomes the measures in the Housing Bill, which give local authorities powers to deal with serious problems with private sector landlords and to require proper licences for HMOs. He should urge his council to use those powers.
	The hon. Member for Peterborough (Mr. Jackson) also mentioned the pressures on social housing and private housing. The Government's response is very clear: we believe that we need to build more homes. The Conservative party have opposed that.

Antisocial Behaviour

John Robertson: What role her Department plays in the development of antisocial behaviour policy; and if she will make a statement.

Ruth Kelly: My Department has made considerable progress over the past year, delivering on a range of commitments set out in the Respect action plan. For example, my right hon. Friend the Prime Minister and I earlier this month announced new regulations that will give arm's-length management organisations and tenant management organisations powers to apply for antisocial behaviour orders.

John Robertson: I congratulate my right hon. Friend on the measures that she has introduced, and I am pleased to hear that her Department is working well with other Departments. Councils have been given the tools and powers necessary to bring people to justice and to protect victims of antisocial behaviour, but does she agree that it is time they used them? How can she make sure that they do?

Ruth Kelly: I do not suppose that my hon. Friend knows that Bolton was the first local authority in the country to sign up to the Respect standard on housing management, which plays an important role in tackling antisocial behaviour. However, he is right to suggest that councils, housing associations and other relevant partners all over the country must play their full role in cracking down on antisocial behaviour. They must use all the tools at their disposal, including ASBOs, as antisocial behaviour can blight the lives of vulnerable people.

Anne McIntosh: Does the Secretary of State agree that ASBOs and fixed-penalty notices do not stop youngsters reoffending, and will she look favourably on our proposal for a national school-leaver programme? Working with the Duke of Edinburgh trust, for example, the programme would encourage young people to take up positive activities, to the benefit of the whole community.

Ruth Kelly: The hon. Lady will be aware of the Government's proposals to encourage young people to be much more involved in their local communities, with activities both on and off school sites, but I cannot agree that ASBOs are not effective. They deal with the hard core of criminals, and I understand that the people who receive them have, on average, 31 convictions each. Moreover, the other measures that can be taken before that point is reached are highly successful in curbing antisocial behaviour, or stopping it altogether.

Louise Ellman: What liaison is there between the Department and local groups involved in dealing with antisocial behaviour? I draw my right hon. Friend's attention to the work of Inspector Nick Mills and his team in the Vauxhall and Kirkdale areas of Liverpool, and the pioneering work of the Liverpool community justice centre.

Ruth Kelly: I should be interested in hearing more about that pioneering work. There are examples of innovative practice across the country. As a result of the Local Government and Public Involvement in Health Bill, which is passing through Parliament and had its Second Reading last night, I hope that local councils will work to the same community safety targets, with the police working to a target agreed with the local authority, the probation service and youth action teams. They will all be working towards the same objective: to combat antisocial behaviour and improve community safety. That will help people to create not only a culture of respect but also better places to live.

Extremism

Robert Flello: What role her Department plays in tackling extremism.

Phil Woolas: My Department leads across Government on the prevention aspect of the Government's counter-terrorism strategy. We also have responsibility for promoting community cohesion, including ensuring that extremists who promote hatred are marginalised. My Department has particular responsibilities for working effectively with local government and engaging with communities to acknowledge and tackle violent extremism at grass-roots level.

Robert Flello: I am grateful to my hon. Friend for that answer and I am sure he will agree that one of the best ways to stop extremists spreading their corrosive poison in our communities is for every decent person to reject the ugliness of extremism with their vote at the ballot box. What is my hon. Friend's Department doing to raise awareness of the importance both of voting in elections to defeat extremism and of getting into communities to stop that poison at the roots?

Phil Woolas: I commend the work that my hon. Friend has done in his constituency to tackle this difficult problem. My Department has a funding stream of about £5 million, which is available to local authorities to help them to put together strategies to tackle those who promote violent extremism. My Department is in conversation with my hon. Friend's local authority in Stoke-on-Trent.

Keith Vaz: What lessons did my hon. Friend learn from the visit to Leicester he made with the Minister for Women and Equality about the way in which a city such as Leicester, where the local authority has worked with the local community for many years, is able to combat racism and extremism?

Phil Woolas: The most important lesson from Leicester is that a strong inter-faith dialogue, talking and agreeing joint action and involving young people—as Leicester has done—makes an investment in the community that reaps rewards for many generations. Indeed, the rest of the country looks to Leicester to lead on the issue.

Councillors

Lindsay Hoyle: How many councillors in England are under 40 years.

Angela Smith: I am tempted to say not enough. In 2004, the National Census of Local Authority Councillors in England and Wales—the employers organisation—reported that of the 18,195 councillors covered by survey responses, only 1,333, which is just 7.3 per cent., were under 40. The review of the incentives for and barriers to becoming councillors announced in the local government White Paper will examine the factors influencing that situation.

Lindsay Hoyle: I think my hon. Friend will agree that that really is not good enough. We must achieve a better age profile. I was elected to a local authority at 22; I left at 39 to come to the House. A sad indictment, because I was one of the youngest councillors and I was leaving the local authority. What can my hon. Friend do to encourage more young people to recognise the importance for their lives of having that voice? We must persuade them that politics is important and that it makes a difference for them.

Michael Fabricant: But look at your grey hair.

Lindsay Hoyle: At least I've got my own.

Angela Smith: Not many of us want to discuss grey hair in the Chamber.
	I agree with my hon. Friend the Member for Chorley (Mr. Hoyle); I was 38 when I left my local authority, Essex county council, and I was replaced by somebody older. It is incumbent on all of us involved in politics not only to set an example to younger people in our constituencies and to engage them, but also to identify the problem. The review outlined in the White Paper, which will look at barriers and incentives, will help us to encourage young people to get involved. I hope that in our political parties we, too, can take on that role.

Nicholas Winterton: I got involved in local government as a county councillor in my late 20s and resigned because, like the hon. Member for Chorley (Mr. Hoyle), I came to this House, but does the Minister agree that what is really important is the commitment of people to local government, not their age? Experience surely counts for something. Does she value it?

Angela Smith: It would be very foolish to stand before the House and say that I did not value the experience of hon. Members and councillors. However, what we generally want to see are local authorities and a Parliament that are genuinely reflective of society. That means people of all ages being involved, so of course experience is greatly valued, but so is the introduction of new and younger members—to councils and Parliament as well.

Local Government Finance

Justine Greening: To what extent her Department will take into account its assessment of value for money in local authority spending in 2005-06 when it determines local authority grant uplifts for 2006-07; and if she will make a statement.

Phil Woolas: The local government finance settlement for 2006-07 was approved by the House on 6 February 2006.

Justine Greening: The Minister will be aware that my local council of Wandsworth received a much lower than average grant uplift this year—in spite of being graded excellent by the Audit Commission and in spite of being rated as the best value for taxpayers' money council in the whole country. How can he justify my local taxpayers getting such a raw deal from Whitehall when the council is doing such a good job?

Phil Woolas: I challenge the hon. Lady's assumption that her constituents are getting a raw deal. Indeed, we specifically provided a floor to protect authorities such as hers that do not suffer the same deprivation—I am not denying that there is some deprivation in her area—as other authorities. Rather than criticise us, I would have thought that the hon. Lady would be thanking the Government for providing a floor to protect the grant, which has been above inflation throughout the Government's period of office.

MSC Napoli

Hugo Swire: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 24, to discuss a specific and important matter, which I believe should have urgent consideration, namely,
	"the situation surrounding the wreck MSC Napoli now lying off the coast in Lyme bay in my constituency of East Devon".
	I would like to take this opportunity to thank the Minister of State, Department for Transport, the hon. Member for South Thanet (Dr. Ladyman) for his courtesy in keeping me informed at all stages. I should also like to record my thanks to the Secretary of State's representative, Robin Middleton, and his staff at the Maritime and Coastguard Agency, to Devon and Cornwall constabulary, to the Environment Agency and others in the emergency services who are working tirelessly to mitigate what could have been a far worse situation.
	The sensitivity of all this is exacerbated by the fact that the Jurassic and Triassic coastline in east Devon and west Dorset is a UNESCO world heritage site. The coastline also includes a number of sites of special scientific interest.
	The media images from the beach in Branscombe show that some members of the public are behaving in a dangerous free-for-all and quite unacceptable manner. The police have felt disempowered at times, not least in their inability to close off the beach straight away. Ministers need to revisit the legislation when events of this nature occur. Although 103 containers have been lost from the ship, to date only 53 have been located on shore. Fifty tonnes of dirty fuel have been washed ashore. Although clean-up operations have commenced and work has begun to discharge the bunker fuel into a reception vessel, that could take a week, during which time the ship, which is between 17° and 25° down at the stern, depending on the tide—is at the mercy of the weather. I am travelling to Brussels tomorrow to meet Jacques Barrot, the Transport Commissioner, to see what lessons can be learned from this incident and to find out what help can be provided to clean up the environmental damage.
	My constituency is largely dependent on tourism and we will need assistance to deal with the fall-out of this incident—in the short and long term—particularly when the wreck is likely to remain where she is for at least a year. My constituents need to be reassured that none of the costs of cleaning this up will have to be met by the council tax payers of East Devon. They also seek reassurance that no more damage will be done to the environment from any protracted clean-up operation and that every step possible is being taken to protect the wildlife affected by the spillage.
	Many questions surrounding the beaching of MSC Napoli need to be answered and I believe that the House should have the opportunity, at the earliest time available, to question Ministers about the events surrounding that unfortunate incident.

Mr. Speaker: I have listened carefully to what the hon. Member has said and I have to give my decision without stating any reasons. I am afraid that I do not consider that the matter is appropriate for discussion under Standing Order No. 24, so I cannot submit the application to the House.

Richard Younger-Ross: On a point of order, Mr. Speaker. I wonder whether you can indicate whether the Secretary of State for Transport has said that—at the appropriate time, when all the appropriate information has been gathered—he will make a statement to the House on the grounding of the MSC Napoli.

Mr. Speaker: It is up to the hon. Gentleman to ask the Secretary of State for Transport. As I have stated, I have not given any reason why I have refused this matter, and I do not want to say any more about it.

Intergovernmental Contracts (Provision of Information)

John Pugh: I beg to move,
	That leave be given to bring in a Bill to require the provision to Parliament of certain information relating to intergovernmental contracts; and for connected purposes.
	The Bill is designed to deal with an absurdity and a scandal, and its genesis is easy to explain. A short while ago, as a member of the Public Accounts Committee, I was prompted to ask why the National Audit Office report on the al-Yamamah arms deal had not been published—a simple enough inquiry, not especially original and not without wider interest. The Committee convened in special session to answer the question. It met in camera, and I am not, frankly, allowed to tell the House what was said or who was there, although I will say that some eminent people were there—people who do not usually attend that Committee.
	I can also say what the outcome, the conclusion, was: we discovered that no one on the Committee—none of the customarily fierce interrogators on the committee, nor the Chairman, nor a single living Member—has a right to see the document, even though it is about a Government contract, even though we can see every other NAO report ever written and even though it was written by a man who is technically a servant of the House.
	The only Member who was ever gifted the privilege of reading was the former Member for Ashton-under-Lyne, Lord Sheldon. Once the reading had been delegated to him, it seemed that no living soul could clap eyes on it again. My Bill seeks to rectify that absurdity. It would not ensure the publication of the NAO report. It would not undo the past. It seeks simply to provide a mechanism whereby Parliament's right at least to scrutinise the doings of Government can be preserved.
	The Bill would apply only to commercial contracts in which the Government are involved. There is force in the argument that, if some of those contracts were exposed to prolonged public debate, the kind of economic benefits that they were designed to secure would be defeated, thus putting at risk jobs, embarrassing international partners or jeopardising other national, perhaps security, interests. I accept that those who point that out make a serious moral claim, but I cannot accept that the House must forfeit the right to examine such a claim and establish whether it has substance or is simply a claim made to cover up a less ethical position.
	When the Serious Fraud Office inquiry was dropped before Christmas in a cunning Government plan that even Baldrick might have bettered, I suggested in the Chamber to the Solicitor-General that the understandable suspicion provoked, and now snowballing, could be allayed by allowing wider access to the report, perhaps on a confidential basis. He pointed out correctly that that was a matter for the House, but he and I both knew that that meant that it was matter for the business managers—the Whips—who can block indirectly or directly any attempt to change the status quo, and believe you me, they will.
	The Bill is an attempt to establish procedure whereby, if sufficient Members make application to the Leader of the House—he is here now—for the scrutiny of documents such as the al-Yamamah report, he must refer those documents to a relevant Committee of the House for scrutiny, perhaps with appropriate caveats. Parliament's right to scrutiny would thus be minimally preserved. I would add that the Committee must refer the issue back to the House if, and only if, apparent evidence of a breach of national or international law was found.
	I strongly believe that such a minimal mechanism needs to exist, if only to show that Parliament is not reduced to the supine, ludicrous position where it is not even allowed to read its own papers, simply because the Government, with a host of obviously shoddy arguments, tell us that it can do us no good.
	We all know that there are pros and cons. Jobs may be lost if we go one way; international and public respect will definitely be lost if we go another. The battle for orders and influence is on one side, and the battle for commercial ethics is on the other. And we can come down on either side irrespective of whether we are moral pragmatists or moral purists. Whatever side we are on, however, we all have to recognise that the Government's current position is simply unsustainable and, like all unsustainable positions, it will only get worse. Thanks to their cack-handed approach, no one now believes that the serious fraud squad was getting nowhere. Everyone now believes that BAE gave out bribes and the Saudis took them. Accusation and allegation, and naming and shaming fill the pages of  The Guardian. The media have, de facto, painted a worse picture than the dear old National Audit Office ever could, or does. Imagination flourishes in the face of the shiftiness that sits on reports, stops investigations and mistakenly tries to rope the intelligence services into the whole charade. The Saudis are not now being criticised; they are being demonised. Our European allies are outraged and the corrupt regimes of the world are smugly vindicated by our apparent and cynical display of grubby realpolitik.
	Parliament perhaps ought to try to rescue the Government from themselves. The Government are aiming for closure, but are opening can after can of worms. The clear plea in the recent official Saudi press release to be able to move on and acknowledge some of the changes made in the kingdom goes completely unheard. That press release, which is on the website, says explicitly:
	"the government of Saudi Arabia today will not and does not condone fraudulent or corrupt behaviour of any kind and would take firm action against anyone found to be involved in fraudulent activity or found accepting or offering bribes of any kind. This is against the law. This should clarify any misperceptions about the Kingdom. We cannot rewrite the past, but we must look...towards the future."
	Without even the most minimal checks and balances on international contracts, the present is clouded by a miasma of suspicion and allegation from which neither BAE, nor Saudi Arabia, nor the Government can get clear. That damages them and wider human and commercial interests. All reputations—including those of Parliament and the Public Accounts Committee—are in the collective mire. To do nothing to avoid further repetition of past mistakes is itself culpable.
	I am reminded of the Government's approach to the British citizens wrongly accused of bomb outrages in Saudi Arabia. I was involved, to an extent, in that matter. What did the Government's hesitant and limp-wristed approach on behalf of innocent Britons lead to? It led to two years of appalling publicity for Saudi Arabia, two years of suffering for the innocent and time bought for the al-Qaeda cell that made and planted the bombs. Let us have no lectures about security from the Government. If we wish BAE to have a business reputation as unsurpassed as its technical excellence, if we wish for an equal and understanding friendship with the kingdom of Saudi Arabia and its people, and if we wish for protection against the next scandal or allegation that is going to ripen, whether from Tanzania or elsewhere, self-evidently we cannot leave matters to the Government. Parliament must assert its right to scrutiny or abjectly acknowledge its impotence. I beg all Members to support the Bill.
	 Question put and agreed to.
	Bill ordered to be brought in by Dr. John Pugh, Nick Harvey, Mr. Michael Moore, Susan Kramer, Dr. Vincent Cable, Lynne Featherstone, Norman Lamb, Simon Hughes and Mr. Paul Burstow.

Intergovernmental Contracts (Provision of Information)

Dr. John Pugh accordingly presented a Bill to require the provision to Parliament of certain information relating to intergovernmental contracts; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 March, and to be printed [Bill 49].

Opposition Day
	 — 
	[3rd Allotted Day]

Health Care-acquired Infections

Mr. Speaker: We now come to the main business. I inform the House that in both debates, I have selected the amendment in the name of the Prime Minister to the motion.

Andrew Lansley: I beg to move,
	That this House, while recognising the commitment and efforts of NHS staff to minimise infection rates, is alarmed at the continuing high levels of healthcare-acquired infections; notes that the NHS is not on track to meet the target for reducing MRSA bloodstream infections in 2008 and that new highly virulent MRSA strains are emerging; is shocked at increasing rates of Clostridium difficile infection which the Department of Health now regards as endemic in the health service; calls on the Government and the NHS to accelerate actions to combat levels of healthcare-acquired infections, including reduced bed occupancy rates, increased isolation facilities and single rooms, improved hand hygiene, enhanced hospital cleaning incorporating novel processes, and the rigorous screening of patients; commends the adoption of a uniform policy within NHS trusts; calls for the piloting by the NHS of a 'search and destroy' strategy against the most virulent strains of MRSA and Clostridium difficile; and demands that the Government report six-monthly to the House on the action it is taking to combat healthcare-acquired infections.
	I want to start, as our motion does, with a recognition of the work that the NHS does to seek to minimise infection. I am sure that many hon. Members visit hospitals, particularly their local hospital, and have occasion to discuss infection control measures, and I am sure that they appreciate the effort being made. I recall visiting a hospital a year or so ago and speaking to a sister in charge of a ward. I appreciated what she had achieved, as there had been orthopaedic patients on that ward for a substantial period, without any infections occurring. One then realises just how much the matter comes down to individual members of staff. I talked to the chief executive as we left that ward, and asked to visit the adjoining stroke ward. He said, "Unfortunately, we can't do that, because it's closed at the moment due to an infection." That made me realise that control of the measures taken on wards makes a big difference.
	We introduced the motion today simply because we have raised infection control issues many times over the past three years, and we want action and need progress. The House needs an opportunity to learn why that action has not been taken, and why that progress has not been made. Our motion this afternoon is intended to provide precisely that opportunity. Let us consider where we are on the issue, and what has been done. In 2005-06, some 7,097 MRSA—methicillin-resistant Staphylococcus aureus— bloodstream infections were reported. That was a reduction of 8 per cent. in relation to the 2003-04 baseline for the Government's target of halving the number of MRSA bloodstream infections by 2008. However, that should be put in context, because the number of deaths associated with MRSA has tripled since 1997. As we said back in 2004, halving MRSA rates would in fact do no more than bring them back to the levels that pertained at the end of the 1990s. Of course, the bloodstream infections that are the subject of the Government's target do not include surgical site infections.
	Since the Government's target was introduced, and even in recent months, more serious and more toxic forms of MRSA have appeared, including PVL—I will not attempt to give its scientific name—a dangerous form of MRSA in which a toxin that attacks leukocytes is emitted. It can lead to conditions such as necrotising fasciitis, which can lead to death in a matter of hours—within 72 hours. Serious and highly toxic forms of MRSA are appearing in hospitals, but the particular form that I mentioned is generally associated with community-acquired MRSA.

Michael Fabricant: Was my hon. Friend as surprised as I was to learn of the move to tell nurses that, to try to avoid cross-infection with the more difficult forms of MRSA, they should no longer simply sterilise their hands using a sterilising wash, but should make it a regular practice to wash their hands? Was he as surprised as I was to hear that injunction, given that one might expect nurses to wash their hands as a matter of course?

Andrew Lansley: In my view, it has always been standard practice in hand hygiene both to use alcohol-based hand rubs and to wash one's hands in between patients. My hon. Friend's interesting point brings me to the next issue. Interestingly, for reasons that I do not quite understand, the Government did not make any reference to Clostridium difficile in their amendment to our motion. One of the consequences of the Government's MRSA target has been a welcome increase in the availability and use of alcohol hand rubs in health care institutions, but that has not been effective in tackling the spread of Clostridium difficile, which requires washing with soap and water, too. One can see how it has come about that the Government's narrow targeting has contributed to the dangers, which have been increasing with Clostridium difficile. The Government have not responded to those dangers.

Phyllis Starkey: rose—

Andrew Lansley: I will give way to the hon. Lady in a moment, but first I wish to put the figures on the record. There are several times as many cases of Clostridium difficile as there are of MRSA. There were approximately 1,300 deaths in which C.difficile was an underlying cause in the last year for which figures were available. Some 2,247 deaths were associated with C.difficile, which is an increase from 975 in 1999, and is twice the number of deaths associated with MRSA. The Government, however, ignore that in their amendment.

David Heath: I agree that there has been a huge effort by staff and the Government to improve infection control. Without wishing to sound too much like an old soldier, 25 years ago, I worked in an operating theatre, and I am surprised by the laxity of procedures now. Some staff, for instance, wear jewellery while in uniform, do not follow aseptic procedures, or wear scrubs outside theatre. A St. Thomas's-trained sister would have scalped people for such surprising practices a few years ago, but the procedures that she enforced do not appear to be part of basic training today.

Andrew Lansley: I accept the point that the hon. Gentleman is making, and I shall come on to it later. It is addressed by the motion, which deals with the availability of facilities, particularly in hospitals, to support the adoption of a policy on uniforms. First, however, I promised the hon. Member for Milton Keynes, South-West (Dr. Starkey) that I would give way to her.

Phyllis Starkey: The moment has passed, but I was seeking to emphasise the fact that a distinction must be made between the level of those increasingly drug-resistant infections in hospital and in the community at large. Hospitals operate against a rising base line, and the hon. Gentleman has ignored that key fact.

Andrew Lansley: It is interesting that the hon. Lady should say so, as I have been speaking for only seven minutes. I shall come on to talk about the technology that would allow us to distinguish between the rising incidence of infections in hospitals and their prevalence. I accept that, in many cases, infections are introduced to hospitals by admissions from the community, and were acquired in the community. New technologies make it possible to make that distinction more quickly, but that leads to the question whether a policy of screening all admissions should be introduced as a result. I shall come on to that in a minute, too.
	Outbreaks of C.difficile are very serious. At Stoke Mandeville, for example, there were 330 cases, in 33 of which, it is believed, the infection led to death. There have been cases in Maidstone, Leicester—the Secretary of State will know about that—and Nottingham. As with MRSA, we are dealing with more virulent strains of the infection such as the 027 strain. Other infections are a problem, too, such as GRE—glycopeptide-resistant enterococci—Acinetobacter and multi-drug resistant TB. I do not dispute for a moment the fact that the Government face a challenging environment, given the prevalence of more toxic infections.

Paul Keetch: The hon. Gentleman will recognise that that is not a new problem. Indeed, my mother died of MRSA in 1996 under the previous Government.  [ Interruption. ] I am not seeking to blame anyone; I certainly would not do so for the death of my own parent. May I ask the hon. Gentleman whether he shares the Patients Association's concerns that there does not appear to be a national across-the-board view about infection control, and that there are variations at local level? We need more information, and people at Hereford county hospital, where my mother died 11 years ago, believe that there should be broader view at the top to make sure that there is a common set of practices to control infection.

Andrew Lansley: I understand the point that the hon. Gentleman makes. He is right to point out that the number of deaths associated with MRSA, which was 49 in 1993, began to rise sharply in 1995 and 1996, as the trend line shows. I do not dispute that. The question is what we are doing now, as much larger numbers of people are dying of causes associated with the infections. Should we specify how every hospital and every member of the NHS should work? Of course not, but we should ensure that the actions that would clearly help, and which are spelled out as necessary by the Health Protection Agency and in the Government's guidance to the NHS, are supported and pushed through by the Government where that has previously not been the case.

David Burrowes: rose—

Andrew Lansley: I give way to my hon. Friend, who had an interesting and important debate last week.

David Burrowes: I commend my hon. Friend for not ignoring Clostridium difficile, which is ignored in the Government's amendment, as he pointed out. That is in marked contrast to the leaked memo, in which the Department of Health official states that Clostridium difficile is now
	"endemic throughout the health service".
	Does my hon. Friend agree that more worrying is the response to which the health official refers—that the Government seek to manage by way of local targets—which is described as a "cop-out"?

Andrew Lansley: Indeed, it is a cop out. The Government must do one of two things. They must set a target and put in place the measures that will deliver it, or they should support the NHS in its local targets. The Government cannot have it both ways. They say, "It is not our responsibility. The NHS hospitals must decide what to do", then they say they want to set a target and achieve it.
	My hon. Friend mentioned the leak in the  Health Service Journal of an internal Department of Health memorandum, in which the director of health protection stated of MRSA bloodstream infections:
	"Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable".
	That is interesting, and a frank admission internally in the Department of Health.
	On 30 November 2004 I had an exchange with the present Home Secretary, the right hon. Member for Airdrie and Shotts (John Reid). I said—forgive me for quoting myself:
	"If he did not pluck a target out of the air, will he tell the House where the evidence base is for his assertion that by 2008 the NHS should aim to halve the current rate of MRSA?"
	The then Secretary of State for Health replied:
	"I am saying that that is where we will be without a shadow of a doubt. . . Where did I get that target? I got it on official advice"—[ Official Report, 30 November 2004; Vol. 428, c. 526.]
	We never saw the evidence or the official advice. Now we see the official advice inside the Department. Officials do not believe that the target can be achieved. I think they are wrong about that. It can be achieved. They never believed that it would be achieved, and they did not give the Secretary of State the advice on the basis of which he plucked his target out of the air. That is just one more example of the right hon. Gentleman in his progress around Whitehall, with his Cabinet colleagues following in their dustcarts.

Andy Burnham: rose—

Andrew Lansley: Perhaps the Minister will explain where that target came from.

Andy Burnham: Now that the hon. Gentleman has seen the advice that was put to Ministers, what does he think is the right response—to redouble efforts or, as he appeared to conclude yesterday, to scrap the target?

Andrew Lansley: It is important to redouble efforts. It is absurd that Ministers say, "The target is marvellous. We will not achieve it, but the target is marvellous." The target has probably contributed to a lack of attention to Clostridium difficile and a 17 per cent. increase in the infection, which has killed twice as many people as has MRSA. Ministers think that the sum total of their objective is a target for MRSA bloodstream infections, rather than to deliver proper infection control across the NHS. They would rather hit the MRSA target, or pretend that they will, than deliver the actions that are necessary. Redoubling our efforts, if the Minister asks—

Andy Burnham: Will the hon. Gentleman give way?

Andrew Lansley: No, I shall make progress. I have been speaking for 15 minutes. There is much more to say about what needs to be done.
	Let me give the Minister another example. Back in 2004 my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), then Leader of the Opposition, and I challenged the Prime Minister and the Secretary of State on the finding in the National Audit Office report that managers were putting targets ahead of infection control advice. The Prime Minister told us that that would not happen, that patient safety would come first and that managers would never do such a thing. Yet the Healthcare Commission report into the Clostridium difficile outbreaks at Stoke Mandeville stated:
	"Other managerial imperatives were given greater priority than the control of infection... The director of infection prevention and control had not persuaded the board to give sufficient priority to the control of infection in general and to the control of  C. difficile in particular."
	 [Interruption.] Labour Members appear to find listening to the Healthcare Commission describing how 33 people died of an outbreak of infection associated with Clostridium difficile funny.
	The report continued:
	"The achievement of the Government's targets was seen as more important than the management of the clinical risk inherent in the outbreaks of  C. difficile. This was a significant failing."
	When did the outbreak occur? It happened between October 2004 and June 2005. Ministers were complacent at the time and they are complacent today.

Charles Hendry: I have a letter from the director of nursing and patient services at Maidstone and Tunbridge Wells NHS Trust to a constituent whose mother contracted C. difficile in Maidstone and subsequently died. It states:
	"The hospital,"—
	the Kent and Sussex hospital—
	"given its age and design is I am afraid totally unsuited to the management of infection and the support of barrier nursing for patients with infectious diseases... The Ward sister... is relatively new... I will ask that her manager ensures, as part of her personal development plan this year that infection control is a key part of her development."
	Should not that have been the case anyway?

Andrew Lansley: Yes. Unfortunately, one of the serious outbreaks took place at Maidstone. We have not received the results of further investigations into some of the outbreaks and it is wrong to assume that the failings at Stoke Mandeville occurred elsewhere. However, I would be surprised if similar failings had not arisen in other places. The Government should have done something about it at the time.
	The Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) asked what actions we would take and mentioned redoubling efforts. Let us consider bed occupancy rates. In 2000, the Government promised the National Audit Office that those rates would go down, but they have gone up. Professor Barry Cookson of the Health Protection Agency rightly said:
	"What all the evidence shows is that we have to get bed occupancy rates to 85 per cent. but the Government has clearly got its waiting list targets and has signed up to them."
	What has happened? We have 9,000 fewer beds than we had 21 months ago. Five per cent. of the NHS hospital sector's bed capacity has disappeared in that time. That is not a consequence of the increasing average length of stay or higher day case rates, but a result of budget cuts.

Anne Main: Unfortunately, my health authority and trusts have the same problem. Dr. Martin Woolaway, the director of public health for my authority, stated in a report to the NAO about preventing infections:
	"Preventing infections continues to be adversely affected by high bed occupancy, the movement of patients and the lack of beds to allow separation of elective and trauma patients."
	Neither of my hospital trusts have isolation wards. That is sadly endemic.

Andrew Lansley: That is disgraceful. Last year, 40 per cent. of nurses reported that they did not have sufficient time to clean beds thoroughly between patients. That is central to proper infection control.
	What about undertaking wider surveillance and inspection instead of the Government's narrow targets? The Minister asked what he should have done in response to the memorandum from the director of health protection. He should have said that the Government would redouble their efforts, not only in relation to MRSA bloodstream infections but a wider range of infections. He should have agreed to disseminate that data and ensured that people could act on the information.
	What about cleaning? The Minister is apparently interested in that and believes that the problem will be solved by in-house cleaning. Why, two years after the publication in 2004 of the model cleaning contract, which was trumpeted as a way of ensuring high standards of cleaning, could Norman Rose of the Business Services Association say that
	"in about all the contract renewals over the past two years, Trusts have requested that contractors do not quote on the basis of the 2004 Cleaning Standards as they cannot afford it"?
	What is the point of in-house or out-sourced cleaning if the management does not try to fulfil the cleaning contract and the model cleaning standards?
	What about the rapid review panel? I am not sure which Minister is now responsible for that. It might be one of the Ministers in the Chamber today, or their colleague in the other place. The rapid review panel was supposed to expedite the introduction of new processes and technologies into the NHS that would be useful in combating infections. Of the 168 products that were assessed, three received a recommendation 1, which meant that they were already in use. Everything else got a recommendation 2 or 3.
	Every company that I have spoken to has the same story about this process. They put together their dossier and provided a great deal of information. That took months, and they received no feedback. They were told that they would be given a recommendation. They were told, "Your product might well be useful. Off you go and prove it yourself. Run a clinical trial. Sell it to the NHS." Those were things that they could and would have done themselves, but for the fact that they thought that the rapid review panel was there to help them to introduce those processes. Instead, it is a paper exercise with a committee that publishes obiter dicta from its throne, and nobody in the NHS is required to do anything about this at all. No one in the Department of Health uses health technology development budgets, for example, to take forward those technologies and prove that they work. Nothing gets done as a result of the so-called rapid review panel.
	Those technologies are out there, however. Last Wednesday, I was at the recently established centre for health care-acquired infections at Nottingham university. In one of the presentations at its launch, it reported on portable clean air technology systems that have demonstrable benefits in reducing MRSA infections, and on a hydrogen peroxide vapour system that has very promising benefits for eliminating Clostridium difficile. But where is the support for that?
	The National Audit Office report stated that more than half of the trusts had undertaken a risk assessment to determine what level of isolation facilities they required, yet only a quarter of those had put the measures in place, and that that had usually happened only in conjunction with new build or major capital projects. That is not good enough, and these things are not happening fast enough.
	Last June, the Scottish health technology assessment reported that three isolation beds per 25-bed ward should be provided to back up a policy of screening all admissions. Will the Secretary of State commit today to providing the necessary capital resources to put in three isolation beds per 25-bed ward in order to support a policy of screening all admissions? The point was raised earlier about tackling community- acquired infection— [ Interruption.] No, you are the Government. I am sorry, Mr. Deputy Speaker. They are the Government, yet they sit on the Front Bench and ask me what I would do. Crikey!
	I was talking about screening. Before the last election, my right hon. and learned Friend the Member for Folkestone and Hythe and I said that, as a Government, we would spend the money necessary to introduce the screening of all admissions. The Government have done nothing about that until the document of November 2006 that they have just published. It states:
	"The logical conclusion of risk factor assessments and the results of modelling studies"—
	the Department of Health always provides us with a good read—
	"is that the most appropriate approach to the reduction of MRSA carriage in the population, and resultant MRSA infections, is the universal screening of all admissions to hospitals."
	Instead of just handing out that document and letting trusts review their policies, will the Government put in place the isolation facilities that would enable the screening of all admissions to hospitals? They say that that should happen, but it is not happening.
	I saw the equipment at the centre for health care-acquired infections at Nottingham university, and it was extremely interesting. Professor Richard James is taking the DNA testing of bacteria to the next stage, which will enable us rapidly to identify the different strains of infection, and of MRSA in particular. Being able to identify the genetic fingerprint of the different strains will enable us to determine the extent to which the MRSA infection in a hospital is the result of a community-acquired MRSA or a hospital-acquired MRSA. This will help us to understand the prevalence of those infections in hospitals.

Andrew Gwynne: The hon. Gentleman has acknowledged that our hospitals now have in place one of the most comprehensive MRSA surveillance systems, so that we can track precisely what is going on. This debate is all very well and good, but will he commit himself to supporting a national health care infection reduction target—yes or no?

Andrew Lansley: That was a completely pointless intervention. We went into the last election with a commitment to a comprehensive programme of tackling infections, not just with a target. We included a commitment to a mandatory surveillance system that was wider than both the one that the Government had at the time and the one that they have implemented now. When we are in government, it will be our responsibility to ensure a comprehensive system of infection control.
	That brings me to two final points. The hon. Member for Somerton and Frome (Mr. Heath) asked about uniforms. It is important to know what the Government are planning in that regard. The Leader of the Opposition has made it clear that we want the code of practice, which the Government put laboriously into legislation last year, to reflect the need for changing, showering and laundering facilities in hospitals. I accept that that will not be cheap, but it is not provided for in the code of practice, and the Government appear unable to commit to it. At the moment, the Royal College of Nursing tells us that half of nurses are not able to change at work, six out of 10 are not able to shower at work—we are all able to shower in Portcullis house, and nurses certainly need that facility at work—and six or seven out of 10 are not able to have uniforms laundered at work.
	The issue relates to nurses' working conditions, the standards that they want to maintain, a comprehensive approach to hygiene in hospitals and the confidence that the public have in the system on which they depend. The Minister said that Chris Beasley, the chief nursing officer, intended to set up an expert group to consider uniforms policy, which was to report in spring 2006. The latest reply in December 2006 said that it will report in spring 2007. Once again, the Government are all talk; there is no action.
	Finally, in relation to "search and destroy", the chief medical officer published "Winning Ways" in December 2003, which set out clearly the success—that is what he called it—that the Danes and the Dutch had achieved with a search and destroy strategy against MRSA. In September 2004, I challenged the Government to say whether they would have a search and destroy strategy. Their answer was that they were getting experts from abroad to come to the country and tell us what we should be doing. I challenged them again to say what they were doing. Lo and behold, more than three years later, Michael White wrote in last week's  Health Service Journal that the chief medical officer had sent a team to the Netherlands to find out about search and destroy strategies.
	We knew in December 2003 that a search and destroy strategy was a possibility. I know why Ministers did not implement it: it is costly, and it would take six years, according to modelling by Nottingham university, for such a strategy to deliver a result whereby MRSA and other infections were no longer endemic in the NHS. The then Secretary of State, the right hon. Member for Airdrie and Shotts, said, "I want a target now, and I want it all to be running in the middle of the next Parliament." He made it up, and it is not good enough. It is not good enough that the Government are not taking action, and it is not good enough that their amendment makes no reference to the commitment and work of NHS staff in combating infections, makes no reference at all to C. difficile, and contains no commitment to further action to deal with infections.
	The purpose of the debate and our motion is straightforward: we are calling for there to be no more excuses, no more complacency, no more targets that distort the task of dealing with infections, and no more rhetoric without results. The Government must commit themselves to action. Our motion sets out the kinds of actions required, which would support and enable the NHS to deliver the highest standards of infection control anywhere in the world, which we need and should aspire to have. Our motion, not least because Ministers have not volunteered any time since the election to discuss infection control, would require Ministers to come to the House every six months to tell us what they have been doing. I commend the motion to the House.

Patricia Hewitt: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the top priority given to reducing healthcare-acquired infections by this Government; recognises that the Government is the first ever to collect data on these infections including establishing the world's most comprehensive MRSA surveillance system; further welcomes the new code of practice for health and social care providers introduced under the Health Act 2006 to reduce infections like MRSA and the new duty on the Healthcare Commission to ensure service providers comply with the code; welcomes the Government setting a target to halve rates of MRSA by 2008; notes the progress towards achieving this target; acknowledges that more must be done to achieve this goal; and therefore welcomes the priority given to reducing healthcare-acquired infections in the operating framework of the NHS in 2007 and the additional £50 million given to NHS trusts in December 2006 to tackle healthcare associated infections."
	I spent yesterday morning with staff and patients at the Royal Marsden hospital in London, an NHS foundation trust that is giving superb care to some of our country's most seriously ill cancer patients. Because patients' safety is the hospital's top priority, it takes infection control extremely seriously. I spent some time with Jen Watson, the senior sister in the critical care unit, who told me about some of the measures being taken. They include regular training in infection control every year for every member of staff, screening of all patients for MRSA when they arrive at the trust, isolation for any patient who is either at risk or diagnosed with MRSA, and alerting the rest of the hospital through the electronic patient record. That is a useful reminder to those who persist in saying that electronic patient records are a threat to high-quality health care rather than a real improvement.
	There are aprons for every staff member in critical care, including doctors, and for every visitor. There are differently coloured aprons for those dealing with different beds in order to reduce the risk of cross-infection. Although the unit has the highest-risk patients in the hospital, it has the lowest cross-infection risks. There is alcohol gel by every bed, and every visitor as well as every staff member is strongly encouraged to use it. There is thorough cleaning and a weekly inspection by the ward sister with the cleaning staff. That applies not just to the critical care unit, but throughout the hospital.

Nadine Dorries: Did the Secretary of State look out of the window and see nurses getting out of their cars in their uniforms, having just dropped their children off at nurseries, or sitting in cars in which they had probably driven their dogs to take them for a walk? What use are the precautions that she has described when nurses are wearing their uniforms home and then wearing them back to the hospital? What is the point of all those procedures when basic, fundamental steps are not being taken?

Patricia Hewitt: I am astonished at the hon. Lady's attack on the integrity and hygiene of dedicated nurses at the Royal Marsden and, indeed, other hospitals. The point about a hospital taking infection control as seriously as the Royal Marsden does and introducing the measures that I have described, along with others, is that infection rates fall. Last year, for instance, the Royal Marsden aimed to lower its MRSA bloodstream infection rates to four cases in that year. In fact, it managed to reduce the number of cases to just two, and it made sure that it learned lessons from each of those cases.
	The detailed description that Sister Watson gave me of the scrupulous attention that the Royal Marsden pays to infection control—attention that is replicated by thousands of staff throughout the NHS in very many hospitals—is a good reminder of what dedicated NHS staff do every day of the week to give patients the safest possible care.

Ann Widdecombe: May I press the Secretary of State on the question raised by my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries)? Does she believe that it is in the interests of hygiene for nurses to wear their uniforms between hospital and home, and between home and hospital? If the answer is no, what does she propose to do about it?

Patricia Hewitt: I think that it is for the board and matrons of each hospital trust to establish the uniforms policy for that trust. I note with some bemusement that while on the one hand the Conservatives propose to abolish all targets, on the other they are telling every hospital where it should put its washing machines. That is an absurd position.
	As the hon. Member for Hereford (Mr. Keetch) reminded us in referring to his mother's death some years ago, hospital-acquired infections are not a new problem and are not confined to this country. We know that MRSA rates have been increasing every year since the early 1990s, and Conservative Members have acknowledged that. We knew when we were elected 10 years ago that there was a serious problem with MRSA and, more broadly, health care-acquired infections, and we have been doing more to tackle it. We were the first Government in the world to introduce mandatory reporting of MRSA—we did that in 2001. In 2004, we set the national target, to which the hon. Member for South Cambridgeshire (Mr. Lansley) referred, for the NHS to halve MRSA bloodstream infection rates by March 2008.

Daniel Kawczynski: rose—

David Burrowes: rose—

Patricia Hewitt: I will give way to the hon. Member for Enfield, Southgate (Mr. Burrowes).

David Burrowes: May I press the Minister again? Why is it that this country, almost uniquely in Europe, supports the practice of nurses' uniforms being laundered at home rather than by industrial laundering, which would ensure proper thermal disinfection?

Patricia Hewitt: If the hon. Gentleman and the Conservative party think that the question of laundering nurses' uniforms is the central issue when it comes to controlling infections—we have already had two interventions in about two minutes on the same point—they are not listening in the real world and they are not listening to the experts.

Daniel Kawczynski: Will the Secretary of State give way?

Patricia Hewitt: I will make a little more progress before I give way again.
	As I say, we were the first Government in the world to introduce mandatory reporting. We followed that up with our target, since when MRSA rates have been falling—not simply because we set a target, but because we focused on the issue with the NHS and we supported it in taking the right action.
	It is worth remembering the scale of the problem that was emerging. MRSA rates began to increase in the early 1990s. Figures from the Health Protection Agency reporting system show that in the last four years of the disastrous Conservative health policy from 1993 to 1996 MRSA rates were doubling, or nearly doubling, every year—an exponential growth in MRSA rates. I have no doubt that if we had not introduced mandatory reporting, made that a top priority for the NHS and set a target, those MRSA rates would have continued to rise. Instead, we first slowed the increase, then we got it down to single figures, and now the NHS is cutting the number of cases. Not only has there been an 8 per cent. reduction in MRSA rates in the past two years, but over the past two years in the NHS in the winter period, when hospitals are at their busiest, there has been an 11 per cent. reduction in MRSA rates.

Paul Burstow: The Secretary of State mentioned the Health Protection Agency. One of the things that it has identified as being a factor behind hospital-acquired infections is bed occupancy rates. Can she comment on the fact that my local trust, Epsom and St. Helier University Hospitals NHS Trust, has decided to cut 200 beds across the trust—one in four of the beds—thus requiring each bed to be used more intensively? Occupancy rates, therefore, will go up. Surely that is a false economy, and there will be a rise in infection rates unless there is very careful investment to deal with the infection consequences of beds being over-occupied.

Patricia Hewitt: The hon. Gentleman raises an important point. For every hospital, patient safety has to be the No. 1 priority. As he will understand, as hospitals do more day care surgery and bring down the lengths of stay by ensuring that patients go home when it is right and clinically safe for them to do so—instead of staying in hospital for an unnecessarily long time, which happens too often—they need fewer beds, while giving patients better care with better health outcomes.
	On the issue of the relationship between occupancy rates and MRSA and other infections, hospitals throughout the country with high bed-occupancy rates are also reducing their health care-acquired infection rates.

Daniel Kawczynski: On my numerous visits to the Royal Shrewsbury hospital, I have noticed that sometimes relatives of patients come to see their loved ones more than two at a time—sometimes three or four at a time—and sit on the beds. Does the Secretary of State agree that it is vital that the Government, via the media, get through to people that they should be very careful what they do when they go to see their relatives? They should not sit on beds. The nurses do not want to enforce that rule, but it is important.

Patricia Hewitt: The hon. Gentleman raises an important point. Many hospitals have introduced protected hours for visiting and controls on numbers, and several NHS foundation trusts engage their members in decisions on such restrictions. However, I must say that, once again, the hon. Gentleman is asking the Government to decide. Does he want us to set a target for the number of visitors that there should be at any one time, or where they should sit?
	Let me say a little more about targets. We set the target of halving the MRSA rate, and I am sure that if we had not set that target the rate would have been going up rather than down and that we would have a much bigger problem than we already have. However, we always said that the target would be challenging—my right hon. Friend the Member for Airdrie and Shotts (John Reid) said that at the time. There is no point in setting easy targets. We need to set challenging targets in order to ensure that everybody makes the greatest possible effort to deal with a problem that affects the NHS as a whole.
	The Opposition are against targets. They have been busy telling the press that they will get rid of all the NHS targets. The hon. Member for South Cambridgeshire has confirmed that they want to get rid of targets—in other words, he has confirmed that he does not believe that the Government should focus on the top priority issues for patients and the NHS by setting a target for reducing the MRSA rate.

Charles Hendry: Does the Secretary of State believe that the Government should have a view on what constitutes good practice? In answering questions on issues such as nurses' uniforms and visiting hours, she said that she did not have a view. Does she have a view on whether it is right for people no longer to wear masks in operating theatres, because people have frequently been told that they cannot be afforded and that there is no money for them? Does she believe that masks being worn in such circumstances constitute good practice?

Patricia Hewitt: I will shortly come on to the action that we have been taking, and supporting the NHS to take, to get the infection rates down, but the hon. Gentleman might find it useful and interesting to look at "Saving Lives: Our Healthier Nation", one of the pieces of useful guidance and support that we have been giving to the NHS to ensure that action follows the setting of targets.
	The Conservatives need to deal with this issue. If they really believe that targets should go, do they think that the NHS should be trying to halve MRSA rates by 2008, or not? Do they want waiting times to fall? Do they want cancer patients—people urgently referred by their GP because they might have cancer—to be got through their appointment with their specialist and their diagnostic tests, and to be started on their treatment, within 62 days? That is the target that we have set, and which has helped to transform cancer care in the past 15 months alone. Do they believe that that target should be maintained and achieved, or do they not mind what the MRSA rates and the cancer waiting times are? In other words, are the Conservatives prepared to set national standards for the NHS and to ensure that they will be followed through, or will they give up, as they did when they had their disastrous years in government?

Andrew Lansley: The Secretary of State has strayed into saying that if there are no targets there are no standards, but of course there are standards. We have been very clear about standards. Our point about targets can be seen in respect of MRSA; they have focused so narrowly on one measure of MRSA infection that other forms of MRSA infection—C. difficile, Acinetobacter and Panton-Valentine leukocidin or PVL—are not being addressed with the comprehensive action that is required.
	The Secretary of State talks about all the actions that she is taking and the documents that are being published. Let me ask her a question about the matron's charter of October 2004. It has a lovely chart that shows how matrons will have the authority to withhold payment. Have matrons actually exercised such a power to withhold payment on any occasion since October 2004?

Patricia Hewitt: Almost every time I visit an NHS hospital I meet matrons who every day act to improve patient care and uphold the highest standards that all of us want. The House and the public now know that the Conservatives would scrap the targets that are helping to reduce infection rates.
	Let me deal with C. difficile—

Andrew Rosindell: Will the Secretary of State give way?

Patricia Hewitt: No; I want to make a little more progress before I give way again.
	It is perfectly true that the national target that we set in 2004 related to MRSA and not to C. difficile, which is also an increasing problem in hospitals not only in Britain, but in almost every developed country in the world. I make two points about that. First, because the MRSA target has focused the attention of every hospital—from the board right down to every ward—on better infection control, it is helping to deal not only with MRSA but with C. difficile and other infections. Secondly, we are seeing very different rates of C. difficile in different hospitals, particularly in respect of the latest, most difficult, strain. That is why, in the operating framework that we set for 2007-08, in which we confirmed that infection control was one of the NHS's top four priorities for the coming year, we also said that we expected every acute hospital, with its local primary care trust, to set a challenging target for bringing down its C. difficile rates, where that was needed.

Andrew Lansley: Local targets?

Patricia Hewitt: Local targets, because there is such local variation in the incidence of C. difficile, which is not something that one can say about MRSA.

Norman Lamb: I am very grateful to the Secretary of State for giving way. Is she really saying that it is appropriate to have a national target for MRSA, despite considerable variation around the country, but local targets for C. difficile because of massive variation? That simply does not make sense.

Patricia Hewitt: That is precisely what I am saying. We set a national target for MRSA because that was a nationwide problem. Although some trusts had very low rates, in most hospitals we expected—rightly—to see very significant reductions in MRSA infections. As I said earlier, and as has been confirmed in many conversations with the experts—the NHS front-line staff—it was because we set that target and focused on MRSA specifically and infection control generally that the infection rate started to come down. However, given that some hospitals are really struggling with outbreaks of the most recent and difficult strain of C. difficile, but others have it well under control, rather than trying to set a national target it makes much more sense to say to the service, as we have done, "Let us have challenging local targets agreed between the hospital and the PCT, but reported nationally not only to ourselves, but to the Healthcare Commission and, most important of all, to the patients themselves."

Andrew Rosindell: rose—

Patricia Hewitt: The hon. Gentleman is being very persistent; I give way.

Andrew Rosindell: I thank the Secretary of State. She will recall, because we have corresponded on the matter, that C. difficile has been a serious problem in Oldchurch hospital, in my constituency. As she is also aware, we now have the new Romford hospital. The death of my late constituent, Mr. Patrick Martin, in 2005 caused a great deal of anguish, but a public inquiry has not been called. Will the Secretary of State please reassure my constituents that although there has not been a proper inquiry and investigation into that incident, the same problem will not be transferred from Oldchurch hospital to the new Romford hospital? Surely it is time that we had a full public inquiry into Mr. Martin's sad and tragic death.

Patricia Hewitt: The hon. Gentleman has indeed written to me about the tragic death of Mr. Martin, and I should obviously like to extend my condolences to Mr. Martin's family. Although it is never possible to eradicate MRSA completely, given the complexities of modern medicine, every avoidable death from MRSA—or any other hospital-inquired infection—is one death too many. That is why, as part of the clinical governance arrangements in the NHS that we have been strengthening since we were elected, it is essential that every hospital learns the lessons from any one of these preventable deaths—and, indeed, from every incident of MRSA or outbreak of C. difficile, even if it does not lead to a death. I am glad that the hon. Gentleman mentioned the new Romford hospital, which is one of more than 80 new hospitals that, under our Government, have been built or are in the process of being built for NHS staff and patients.
	I want to stress that even with 12 million people admitted to hospital every year, and such tragic cases as the one to which the hon. Gentleman has just referred, the risk of MRSA bloodstream infection remains very low, with fewer than two cases for every 10,000 hospital bed days. However, we also know that we can and must do more with all such infections. That is why in 2005 the chief nursing officer launched the national programme "Saving Lives", which was based on the best available information, guidance and practice from the UK and internationally. The programme was designed to focus the efforts of every hospital on a small number of high impact clinical interventions, and it has done so. All the evidence shows that if a hospital implements those measures consistently, it will reduce the rate of all those serious infections.
	Let me quote Peter Wilson, the consultant microbiologist at University College London Hospitals Foundation Trust:
	"Even though UCLH had high levels of MRSA bacteraemia in 2001, we have been successful in reducing them substantially by being focussed on the task and gaining the full support of the chief executive."
	He says that the trust has introduced
	"wound surveillance and rapid MRSA screening in addition to increased use of hand gel and hand hygiene education."
	He claims:
	"Any hospitals using similar strategies should be able to achieve the MRSA target. Antibiotic control has also ensured low levels of C difficile."

David Heath: The Secretary of State is probably entirely right to say that proper interventions and protocols can reduce bacteraemia in the hospital environment, although part of the equation is having the capacity to isolate cases, which comes back to the bed occupancy issue that my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) raised earlier. However, can anything be done to reduce the proportion of the resident population of Staphylococcus aureus that is methicillin resistant? Is there any public health measure that has been shown to be effective in achieving that?

Patricia Hewitt: The hon. Gentleman makes an extremely important point. Hospitals have found, as a result of the monitoring that we have asked them to do, that MRSA is present in some 20 per cent. of patients admitted from nursing homes and 7 to 8 per cent. of patients admitted as emergency cases. At this point, the most useful action, and one that we strongly recommend to the NHS, is to screen high risk patients, especially elderly people, those coming in for orthopaedic surgery—emergency cases as well as elective—and patients coming in from nursing homes. That is precisely the guidance that the chief medical officer and chief nursing officer issued last year to supplement the guidance that we had already issued in "Saving Lives".

Andrew Lansley: I am surprised by those remarks because I have read "Saving Lives" on the summary of best practice in screening for MRSA, and I quoted from that document in my earlier remarks the conclusion that the best way to deal with it was universal screening of all admissions. The Secretary of State is now saying that her recommendation is different from what her own document said.

Patricia Hewitt: The guidance that we issued last year on screening recommends strongly to trusts that they focus their efforts on those most at risk —[ Interruption. ] Well, I will send the hon. Gentleman a copy of the document because I have just been looking at it. It sets out in great detail the different groups of patients most at risk of MRSA and other infections —[ Interruption. ]

Mr. Deputy Speaker: Order. The hon. Member for South Cambridgeshire (Mr. Lansley) may not like the answer that he is getting to his question, but he must listen to it without continually intervening from a sedentary position.

Patricia Hewitt: I am grateful to you, Mr. Deputy Speaker.
	We have issued that further guidance and we expect it and other guidance to be implemented. However, a critical element in the action needed to ensure that targets are taken seriously and achieved is our investment in improvement teams. Those teams work directly with the acute hospital trusts that are finding it most difficult to get infection rates down. In the past year, they have worked with more than 50 trusts, and that is exactly the same approach that we adopted in our work to improve accident and emergency services. Our aim then was to get rid of the appallingly long waits on trolleys in corridors that people had to suffer, and to cut waiting times. For example, when the teams began work, people were waiting for hip replacement operations for 18 months or even two years.
	That is an example of how we set a target, focus attention on it and then send in improvement teams to work with those hospitals that are struggling the most, but we have done more than that. The hon. Member for South Cambridgeshire spoke rather scornfully about the Health Act 2006, but I think that it represents a hugely important step forward, as it gives us the power to introduce a statutory code of practice as part of our campaign to save the lives of more NHS patients.
	The 2006 Act came into effect last October and it requires every NHS trust to have proper systems in place to deliver effective infection control. The Healthcare Commission will assess compliance with the code of practice, as part of the checks on the quality of health care that it makes on behalf of all patients. Already, 41 trusts have carried out self-assessment exercises and declared that they were not doing enough to control infections. The Healthcare Commission is following up each of them to ensure that effective remedial action has been taken.
	If the Healthcare Commission finds that a trust has not taken effective remedial action to deal with infection control problems, it will be able to issue statutory improvement notices that require the trust to remedy the failure within a specified period. I assure the House that it will have no hesitation in doing so.

Justine Greening: I thank the Secretary of State for giving way—[ Interruption.] I am delighted that her Front-Bench colleagues have woken up enough to hear my intervention. The right hon. Lady talked about quality control, but is not what she said at odds with the Local Government and Public Involvement in Health Bill that we debated yesterday? Under that Bill, the public and patient involvement forums are to be turned into local involvement networks. The forums' ability to hold trusts accountable for their performance in respect of hospital-acquired infections is a very important element in ensuring that targets are met, but do not the new proposals simply water that down?

Patricia Hewitt: The hon. Lady is absolutely wrong. The system is not being watered down, as the success of the patient and public forums provides the basis for the much stronger system being put in place with the local involvement networks. We have been able to make an enormous difference to the quite shocking standards of hospital hygiene that we found when we were elected 10 years ago, precisely because of the work of patient environmental assessment action teams that go into hospitals and make unannounced inspections on behalf of patients and the public.
	Although all of our work—with "Saving Lives", the new screening guidance, the new code of practice, stronger powers for the Healthcare Commission and with the improvement teams—was having an effect, we remained unsatisfied. Infection rates for MRSA were falling, but not fast enough, so last month we announced a further allocation of £50 million in capital funding—[ Interruption.] The hon. Member for South Cambridgeshire should listen, as he was asking for more capital funding. That £50 million in capital funding was made available to enable hospital trusts to buy equipment and carry out work so that they could further improve hygiene and reduce the risk of infection.
	I can announce that, as of today, £45 million of that £50 million fund has already been released to trusts. They are using the money to build more single rooms for isolation treatment, to install more hand-washing basins and to modernise bathrooms, and to put in safe storage containers for dirty linen where they are needed. Trusts are also using the money to acquire new equipment for the heavy duty, deep steam cleaning of infected rooms and wards, and they are buying new wipe clean computer keyboards for theatres and new equipment for microbiology laboratories. Further investment in the national health service, made possible by the record investment that our Government are making in the NHS—investment that the Conservatives voted against—[ Interruption.] They do not like to hear that, but they will hear it. That investment would be put at risk every year by the Conservatives' new economic policy; they would cut funding for the NHS and other public services to pay for tax cuts.
	We know that getting infections under control has to be a top priority for the NHS, which is exactly what we said in the NHS operating framework for the next financial year. Cut infection rates, cut waiting times further, reduce health inequalities and achieve financial health—the top four priorities for the NHS for 2007-08. Those are all targets that the Conservatives would scrap. All those achievements would be put at risk by their health and economic policies.
	I commend the amendment to the House.

Norman Lamb: The debate has clearly been inspired by the leaking of the now infamous Department of Health memorandum, which painted a disturbing picture of the trends in health care-acquired infections. In the aftermath of the leak of that document, the headline focus was on the MRSA target, but as the hon. Member for South Cambridgeshire (Mr. Lansley) rightly said, the previous Secretary of State made an absolute commitment not merely to move towards that target but to meet it. It is right, therefore, that the Government should be held to account on their progress in achieving that absolute commitment.
	What did the memorandum highlight? It said that the target would not be reached—indeed, that it may never be reached. That was the view of the director of health protection at the Department of Health. It was not the case that merely a few trusts were performing badly; there was underperformance across the NHS—116 trusts were underperforming. I fully acknowledge that MRSA rates are coming down, which has not been achieved from the mid-1990s onwards, when rates were rising considerably.
	The whole NHS is off course by a massive 27 per cent., compared to the absolute target set by the previous Secretary of State. Perhaps most disturbingly, according to the director of health protection, Clostridium difficile is endemic throughout the health service. The Secretary of State said that the situation was variable, which I accept, but almost all trusts are reporting cases. There are far more cases of C. difficile than MRSA, and far more people are dying from it. In 2004 there were 360 deaths from MRSA but 1,300 from C. difficile, and in 2005-06 there were 51,000 cases of C. difficile.
	Rather disturbingly, the memorandum reported that measures to combat MRSA do not seem to have an effect on cutting rates of C. difficile. Among the over-65s, incidence of C. difficile increased by 17 per cent. between 2004 and 2005. According to the director of health protection, there is evidence that many trusts do not take the problem seriously enough—an issue to which I shall return. As the Conservative spokesman pointed out, the memo provides compelling evidence of the extent to which the Government's obsession with targets can be counter-productive and unhelpful in achieving a focus on the highest priorities.
	How did we end up with the MRSA target? Why focus only on that infection? Back in 2004 there were rapid rises in MRSA infection, which, as the Secretary of State will remember well, caused a political storm. The response, of course, was to set a tough target, but it was a target only for MRSA, because that was the media story. The memo is revealing about what civil servants think of the value of that target. Three of the six options for how to manage the bad news involved changing the target. It could be extended by adding something on C. difficile, which would show equal concern for that, or changed to cover hospital-associated infections generally without mentioning any specific ones. Switching to locally set targets was another option that would allow C. difficile to be included in local targets. Another option was scrapping the targets altogether or extending the time scale.
	It seems to me that that hardly demonstrates a massive commitment to a target that the Secretary of State put such store by. The director of health protection appears to have a different view from that of the Secretary of State about the significance and value of this specific target. One is left with a clear sense that the original target was entirely arbitrary, as the hon. Member for South Cambridgeshire said, and that the director of health protection took the view that it would be sensible to acknowledge that it neglected other infections, and that changing it might well get trusts to take the problem of C. difficile more seriously.
	The conclusion, though, was to plough on with the existing target—however narrow, however much it ignored the bigger problems of C. difficile, and however unattainable it was. As we have heard, the focus for C. difficile is to go for local rather than national targets, but the truth is that the target for MRSA, set on the basis of political calculation, distorts clinical priorities. I shall return later to the issue of how other targets may be compromising efforts to combat these infections.
	There is nothing in the Conservative motion with which to disagree. It is right to highlight the challenge that we face and the seriousness of the issue when so many people are dying as a result of infections picked up in hospital. However, it falls short in one crucial respect. Remarkably, it says nothing about the role of antibiotics in health care-acquired infections. If the motion were a prescription for how to tackle the problem, it would be seriously deficient for that reason.
	On antibiotics, I would like to highlight the work of Professor Liebowitz, a world authority on hospital-wide infection, at the Queen Elizabeth hospital in King's Lynn. That hospital has achieved the Government's MRSA target and also cut the incidence of C. difficile very significantly—by more than 20 per cent. in the last two years. What Professor Liebowitz stresses is the importance of stopping the prescription of the so-called broad-spectrum antibiotics and looking at alternatives. Just last week, she told the Norfolk health and scrutiny committee:
	"It's really frustrating if you have got really good infection control, everybody is washing their hands, but still doctors continue to treat with the same antibiotics"—
	thus undermining everyone else's efforts in seeking to control these awful infections.
	Those concerns were echoed in a national survey of NHS acute trusts in England, carried out by the Health Protection Agency and the Healthcare Commission, which specifically looked into C. difficile. Crucially, what the survey found was that the most effective measure in preventing and managing infection is the appropriate administration of antibiotics in hospitals. Given that that is the advice of the Health Protection Agency, it seems incredible that hardly any reference has been made to it in our debate so far.

Paul Keetch: In common with other hon. Members, my hon. Friend has referred to the washing of hands, which is so important. However, would he accept that it is not so much the washing as the disinfecting of the hands that is so important—and also ensuring that the hands are not re-infected through bracelets or rings? The skin must be properly disinfected before injections or tubes are put into the skin. It is not just washing but disinfecting the skin that is crucial here.

Norman Lamb: I absolutely accept my hon. Friend's point and I will come on to some broader comments about infection control in a few moments, but let me just finish on the question of antibiotics.
	The advice was that trusts should have policies in place to reduce the inappropriate administration of broad-spectrum antibiotics and the regular monitoring of the use of antibiotics through audit and feedback to prescribers. Those findings are also reflected in the results of the European Commission-funded research project, which reported in September 2005. Antibiotic use has a significant impact on MRSA in European hospitals: the hospitals with the highest MRSA prevalence also had the greatest antibiotic use. So not only is the Government's approach flawed for the reasons that I have explained, but the motion leaves out probably the most significant factor in tackling the problem.
	The questions that I would put to the Secretary of State are these: what specific steps are the Government taking to shift the prescribing of antibiotics away from broad-spectrum antibiotics? How successful are those steps? What are the trends in prescribing? I do not know whether she wants me to give way to her, but I would be very interested in what she has to say on those specific points. I see that she does not want me to give way, but I very much hope that the Minister will deal with them in his response to the debate—that would be encouraging news.
	The motion rightly deals with a range of infection control measures, which the evidence suggests are also important in dealing with the incidence of health care-acquired infections. What is remarkable is the extent to which the Dutch have been successful in keeping rates of infection much lower by adopting a zero-tolerance approach—the "search and destroy" strategy referred to in the motion. The Netherlands uniformly screens for MRSA and isolates those infected. Staff are sent home and wards are often closed down. However, the key to enabling that approach to work is to have enough beds for isolation, as well as good staff-patient ratios.

Patricia Hewitt: Will the hon. Gentleman give way?

Norman Lamb: I will. Perhaps the Secretary of State is ready to answer my questions now.

Patricia Hewitt: No, I am not intervening on the antibiotics issue, although that is an extremely important point and one that we have endorsed in the guidelines. Is the hon. Gentleman aware that in the Netherlands the rate of hospital-acquired infections is about 7 per cent., and that in England it is about 8 per cent.? Although there are undoubtedly lessons that we can learn, and are learning, from our colleagues in the Netherlands, I deplore the fact that the hon. Gentleman is talking down the achievements of the NHS in that way.

Norman Lamb: I am not talking down the achievements of the NHS in any sense whatsoever; I am saying that we should be prepared to learn the lessons if measures have been seen to be effective in other countries. Indeed, the Conservative spokesman referred to the fact that the Government had previously accepted that there were lessons to be learned from abroad. It appears that that is no longer the case, and I am saddened that there seems to be a move away from objectivity and rationality to rather cheap point scoring.
	I return to the key point that sufficient beds are needed to make the approach work—especially to ensure that isolation is possible and achievable. Bed occupancy in the Netherlands is about 60 per cent. In the UK it is nearly 85 per cent., and in many acute hospitals it is much higher. In 2004-05, 88 trusts—one fifth of the total—had occupancy rates of over 90 per cent. According to the evidence, there is a direct correlation between occupancy rates and infection. Frequently acute trusts are full, on black alert. I have just discovered that the Norfolk and Norwich hospital was on black alert—in other words, absolutely full—on 27 days in the year to the end of October 2006. That is not uncommon; it is frequently the case in many very busy acute hospitals.
	In 2000 the National Audit Office highlighted concerns over bed occupancy, as well as the pressure on hospitals to keep down waiting lists. Not a political party, but the independent NAO recommended a modest reduction in occupancy rates to 82 per cent., but that has not been achieved. Why has it not been achieved? One of the main reasons is an aggressive cut in the number of beds: 6,000 were lost in 2005-06.

Patricia Hewitt: indicated dissent.

Norman Lamb: The Secretary of State shakes her head, but it is true: beds have been lost. Increases in day procedures have not kept pace with the cuts in the number of beds, which has resulted in occupancy rates remaining dangerously high. Disturbingly, the NAO also found that 12 per cent. of infection control teams reported that their chief executive had refused or discouraged a recommendation from them to control an outbreak by closing a ward or hospital to new admissions. That reflects pressure to keep beds open. I do not know whether that is still happening.
	That finding highlights another impact of inflexible and conflicting targets. The overwhelming political capital invested in cutting waiting times, at the same time as many hospital trusts are struggling with large historic deficits, has resulted in dangerously high occupancy rates, as beds have been cut too fast. That view was specifically supported by the Public Accounts Committee in 2005. It found evidence that bed management policies and the need to meet waiting time targets can compromise infection prevention and control. We also heard of the report from Stoke Mandeville hospital, which found exactly the same evidence of the link between bed numbers and pressure to fill beds because of waiting time targets, and levels of infection.

Daniel Kawczynski: I concur with the hon. Gentleman about the fact that bed occupancy can play a major role in the spread of MRSA. Between now and February 16 beds will be cut in the maternity service at the Royal Shrewsbury hospital, and I fear that that will have a significant impact and will increase MRSA in the maternity service.

Norman Lamb: I am grateful to the hon. Gentleman for that intervention. A large number of beds are being cut across the country. That is directly related to deficits. It may well be appropriate, in certain circumstances, to reduce bed numbers. They can be reduced over time, as there is a shift towards day procedures. However, if numbers are reduced too fast, to meet the demands of deficits, we get problems. That is what the Public Accounts Committee found in 2005.
	Last year, a Department of Health internal policy review was leaked to  The Independent. It showed a direct link between bed occupancy and infection rates. Do the Government accept that link? I would be interested to hear the Minister say whether he accepts it. Further evidence of an inadequate response in this country, particularly to the growing problem of C. difficile, came from the national survey carried out by the Health Protection Agency. It confirmed that rigorous infection control measures—the rapid isolation of patients, effective hygiene and clean environments—were critical. It found that only 40 per cent. of trusts routinely isolate patients with C. difficile. That is a hopeless record across the country. That is not rubbishing the NHS; it is a statement of fact that ought to cause the Government real concern.
	The survey also found that trusts have no agreed definition of an outbreak and are unclear to whom they should report an outbreak once it has been identified. Again, that is not acceptable. If the Government were prepared to accept that these things are not acceptable, we might start to make some progress. On the basis of those findings, it is hardly surprising that the survey also found that two thirds of trusts confirmed that the incidence of C. difficile had increased in the previous three years.
	My question to the Secretary of State and to the Minister who will respond to the debate is: how have the Government responded to the findings of that national survey conducted by the Health Protection Agency? Given the highly disturbing evidence revealed in the leaked memorandum that C. difficile is now endemic in the health service and that many trusts are not taking it seriously—that is not us rubbishing the health service; that was said by the director of health protection—what steps are the Government taking to change that mindset? Will the Secretary of State acknowledge that contradictory targets may be making the situation worse?
	Given just how many people are dying from those infections, I am sure that no matter which side of the political divide we are on, we all agree that the state of affairs is completely unacceptable, and that urgent action needs to be taken to improve performance across the health service.
	On cleaning services, I should like to explore a report in the  Health Service Journal, which says that the Minister will recommend that trusts consider bringing cleaning services back in-house. It was reported in the  Health Service Journal that a report including that recommendation was due to be sent to the Prime Minister this month. Will the Minister confirm that?

Andy Burnham: You shouldn't believe everything you read.

Norman Lamb: The Minister may say that, but I would be grateful if he confirmed, in this debate, whether that claim is true. Will he publish the report that he is sending to No. 10, as that would be helpful? Is there any evidence that contracted-out services perform to a lower standard? I do not know, but the union Unison published a research paper two years ago in which it was claimed that contracted-out hospital cleaning had resulted in a lower standard of cleaning. The research paper said that the number of cleaners had halved since contracting out was first introduced by the Conservative Government. Does the Minister accept that evidence? Judgments should surely be made on the basis of evidence, and if the claims are true, we all have something serious to think about.

John Pugh: My hon. Friend will be aware that financial pressures play their part. For example, in my local hospital the turnaround team that is sorting out the hospital's finances insisted that the hospital reduce its cleaning regime, even though it has a good record on MRSA. Is that not a further anxiety?

Norman Lamb: It is. So many negative measures are driven by the financial crisis affecting much of the health service, particularly during this financial year. Before Christmas, the Select Committee on Health highlighted the fact that so-called soft targets are often affected, even though in the long term, those soft targets are often among the most vital parts of the operation.
	Does the Minister agree with the Royal College of Nursing's proposal to introduce 24-hour cleaning teams, which could be rapidly deployed by nursing staff? It seems an eminently sensible proposal. We must surely ensure, too, that every front-line NHS staff member receives compulsory training. In an earlier intervention, my hon. Friend the Member for Somerton and Frome (Mr. Heath) made the point that basic standards of cleanliness are not what they used to be. That may well come down to inadequate provision of the training necessary to ensure that those high standards are maintained. Will the Government commit to providing that training? There should be a thorough review of isolation facilities, with a timetable for improvement. Will the Minister commit specifically to that, too?
	This subject is incredibly important. It is clear from an accumulation of evidence—evidence confirmed by the infamous leaked memorandum—that the current strategy is not succeeding, that far more needs to be done, that efforts to minimise the number of tragic deaths that occur as a result of health care-acquired infection must be prioritised, and that must not be compromised by action taken because of other, politically driven targets.

Laura Moffatt: It is a pleasure to follow the hon. Member for North Norfolk (Norman Lamb), who made an interesting contribution. I did not wholeheartedly agree with it, but it took a thoughtful look at the difficulties surrounding health care-acquired infections. I was particularly interested to hear his exchange with the hon. Member for Hereford (Mr. Keetch) on the issue of hand-washing. That exchange exposed one of the complexities of the subject, namely, the fact that it is not only hand-washing technique that is important, but the agent in which hands are washed. All the anti-bacterial solutions in the world will not tackle Clostridium difficile, because it is a spore, and it has to be dealt with in a very different way. I hope that that highlights some of the problems that we face.
	If I were still in my former profession and took a swab to Members' noses in the Chamber and other interesting little places, many of us would be found to be carrying Staphylococcus aureus, which can cause harmful infections. That is the reality and the difficulty of the situation that we face. I do not often turn to the  Evening Standard—it is not my chosen publication— for sensible contributions to debates in the news, but yesterday's article by Dr. Mark Porter on the cause of health care-acquired infections was excellent. It did not get into silly nonsense about whether the problem was caused by this Government or that Government, but it outlined where the difficulties are. Dr. Porter said: "Indeed, you"—meaning the public—
	"are more likely to catch it from yourself."
	That is the absolute truth. Many people who are admitted to hospital, particularly for a surgical intervention, may well have the MRSA bug or any one of 16 or so other infections. Once those infections are introduced into the bloodstream, bacteraemia arise. We need to tackle the problem, and the Government are taking it seriously. We cannot pretend that it is only the Government's responsibility and ignore the excellent initiatives by trusts up and down the country. Many of those initiatives are the result of the mandatory requirement for trusts to report MRSA, which is a significant driver that empowers not just trust board members—in an excellent initiative, many boards now have a member with specific responsibility for reducing infection—but all the staff who work in our fantastic NHS.
	The most important improvement that has allowed us to make headway in tackling all those health care-acquired infections is the provision for nurses to take a leadership role. To many of us who spend time in our local hospital—recently, I have had to do so more often than I would wish, as my parents have been unwell and have undergone surgical procedures, as did my son the week before last, although he was on a different ward—it is obvious whether those initiatives are taken seriously and a leadership role is adopted by the ward manager. When I go on to a ward and see at every bedside a gel dispenser and, at the entrance to the ward, huge signs explaining that it is important to take precautions to prevent those infections from being taken on to the ward and transmitted to vulnerable people, I know that that the problem is being addressed.
	My knowledge derives not just from recent experience as a ward visitor but from my experience as a nurse on an isolation unit before coming to the House. I become increasingly angry when I listen to debates in which people say, "It is all the Government's fault, because they have not done anything about it." May I gently remind Opposition Members that, having worked on an acute isolation unit throughout the 90s, those beds were increasingly filled by people who became MRSA-positive during their stay in hospital? There was no requirement to count the number of individuals who became infected, but we lost many people, because they were very poorly in the first place, and thus succumbed to infection. However, there was no drive to deal with that matter, and no interventions that allowed us to ensure that those patients did not become infected. It was almost as though we were supposed to tackle the infection in the isolation unit, but by then it was far too late, of course. That is not where the work is valuable. It must be done at a much earlier stage. That is why I am firmly convinced that the problem is a collective one, and that we must work with health care professionals.
	I found the Opposition motion very mealy-mouthed about health care staff, particularly those in our hospitals. The motion states how strongly the House supports them, and then goes on to criticise them for their practices and the work that they are doing. I shall outline some of the work that I have been doing in conjunction with nurses, and the work that has been going on with the trade unions and the Royal College of Nursing to promote good practice among staff, and to spread good practice among all staff, not just nursing staff. It is important that each care giver in a ward setting be included in training programmes. That is exactly what is happening.
	It is obvious that if nurses are delivering 80 per cent. of the care, they will take a leading role in how we tackle these matters, as they are doing. Last year the Royal College of Nursing launched a good campaign in conjunction with the Government, called the "Wipe it out" campaign. It gave excellent advice to staff in hospitals—for example, on how to tackle MRSA, how to deal with uniform issues, and how to deal with the indwelling devices that are inserted in some patients, such as a urinary catheter or a nasal gastric tube. That work has led to the empowering of front-line staff to try and think of new ways of tackling infections.
	I have read articles that would make Florence Nightingale turn in her grave. She, of course, was very much aware of infection. More people died of the infection that they acquired at the hospital at Scutari than died of their wounds, but that was before antibiotics. None the less, the problem existed for them.
	There is no doubt that we could take punitive measures. We could tell trusts that we do not want them to admit certain patients, or not to allow their relatives to visit them in hospital if we are not sure of their personal habits. We could say that we do not want children to visit during their parents' or grandparents' stay in hospital, even though contact with their families makes patients' stay in hospital much nicer. I have little doubt that we could reduce the amount of infection that is brought into hospitals, but we do not do that because we know the psychological effect that that would have. So we have to think differently about the impact of the people who visit.
	I recently watched a family who had come to visit their grandfather in hospital. The little six-year-old girl said that she wanted to go to the toilet, and toddled off alone to the visitors toilet. She was gone for some time, then returned. It was a surgical ward and the grandfather had undergone surgery. I have no idea whether the little one had managed to do all that she needed to do and wash her hands. It is clear that many of us have a responsibility within that setting.
	I have no hesitation in saying that we should give good and sound advice to families who visit, and many hospitals do. Excellent advice is also offered to those who come in for surgery. My son recently underwent arthroscopy and was told that it might be a good idea to use an anti-bacterial wash for a week before he went in, thus reducing the risk of self-infection. That was sensible. He received excellent, timely care and had a fantastic discharge. I hope that all patients can have a similar experience.
	There are many ways in which front-line staff and visitors can collaborate. I have no hesitation in telling people who go to hospital, either as patients or visitors, that they should challenge staff if they feel that the practices that they have seen are not good enough. We should be able to say, "This is our NHS and we want some reassurance that hand washing is going on." I suspect that that happens nine times out of 10 and that people have a good experience. However, we must take a collective interest in care delivery.
	When I was nursing and increasing numbers of MRSA cases came to our ward, we were relieved of wearing our caps because, we were told, they might introduce infection. Frankly, reorganising the deckchairs on the Titanic comes to mind. Yet the public debate is often handled in that way. It does not concentrate on the issues that we need to discuss.
	There should be collaboration with, for example, community nurses on the way in which we hand over people, who may have been vulnerable at home for some time, to the acute setting for surgical procedure or medical admission. We should ensure that the person being admitted is as clean and clear of infection on the skin as possible, and not a carrier of the conditions that we are discussing. That must also apply to the private sector. We find that elderly, poorly people are often admitted to an acute setting as emergency cases, and the issue of health care-acquired infections has not been tackled. Repeated admissions also cause enormous difficulty. We do not do justice to those on the ground who try to make serious headway in tackling the problems.
	I am interested in the focus on uniform policy. The advice not only from the Department but from the RCN "Wipe it out" campaign is clear about not wearing a uniform in a public place. I get so angry if I see anyone in a uniform toddling around ASDA and thinking that it is all right to push a trolley. Not long ago, I tackled someone who turned out to have come from a private nursing home. She was wearing a short uniform and some trousers. I was worried about her walking around a public place in uniform. It is time to outlaw wearing uniforms outside work and ensure that proper facilities are available.
	Most hospitals have reasonable changing facilities. They must have either good laundry facilities or enough uniforms to ensure that laundry can be done at home but that a clean uniform is worn each day. None of that is rocket science but it shows how seriously a trust is taking cleanliness and how it disseminates that practice among the staff.
	There has been a huge improvement in our local trust, and our local hospital—which is now run by the local doctors in the PCT—in that they now have evening cleaning teams who ensure that the place is clean and tidy and that the public toilets are cleaned. There is also a telephone number that is always staffed so that people can call to report any toilets that are not as clean as they should be. All this contributes immensely to ensuring that our hospitals are as clean as they should be.

Norman Lamb: I am interested to listen to the hon. Lady's speech, which is obviously based on experience. I mentioned earlier the proposal by the Royal College of Nursing for 24-hour cleaning teams who would be available at the instruction of the nurses to clean whatever areas needed cleaning. What does the hon. Lady think of that proposal?

Laura Moffatt: We have to think about the local setting. Some wards will not require that service, but others certainly would benefit from that particular boost. That is why I am interested in the local credit card system that the managers have in some wards. Some places have decided to spend their money on that system to ensure that they have access to a gold-plated cleaning service. Such services should be available at the behest of the ward manager, if she chooses to use them. We have heard how complicated the link between cleanliness and MRSA can be, but the use of such services would be an illustration that a particular ward was taking the issue seriously.
	I have little doubt that much is being done throughout the NHS to tackle this matter. The numbers of those infected, particularly with bacteraemias, is beginning to reverse, thank goodness. Those who are infected are also showing an improvement, despite the increased activity. We need to highlight that point, because much has been said today about the reduction in beds and the resulting increased activity, but the reality is that headway has been made.
	We can trust our hospital staff to deal with this matter, but we must work in partnership with them. As a passing shot, I have to say—as a former member of the nursing profession—that the medical profession is not exactly blameless in all this, to say the least. I hope, however, that the days of hard-pressed senior house officers and registrars walking from bed to bed in their grubby white coats are over. In our local trust, I have noticed that they are now using greens from the theatre, which are changed daily. It is a much better practice to wear a fresh outfit every day.
	Many of our medical schools—especially in Sussex, I am delighted to say—now offer a new module covering the reduction of hospital-acquired infection as part of the training for undergraduate doctors, which is a big step forward. I should like to see them go a step further and to deliver those classes to their nursing colleagues as well, so that doctors and nurses can discuss ways of tackling these issues together.

David Heath: My experience of theatre work is that it is very much a shared endeavour, and that the surgical team, the anaesthetist, the operating department's assistants and the theatre nursing staff all understand that they have a shared responsibility for asepsis. I am not sure that that is always the case on the wards, however, and the points that the hon. Lady has made on that are very valid.

Laura Moffatt: I thank the hon. Gentleman for his intervention, but I firmly believe that that situation is changing. When a leadership role is taken by the ward manager, everybody understands, throughout the setting, how important cleanliness is. However, it is also about training. In the protected hour, when patients have a quiet time—there are few enough of those on our wards, which are busy, care-giving settings—the ward manager recently held a training session, often interrupted by calls from patients, to talk to the cleaner about the different cleaning agents that need to be used to tackle all the infections that we face.
	I am not in the least depressed about the rate at which we are tackling such infections, as a tough target has been set. When the previous Secretary of State announced it, most of us knew that it would be tough. Without it, however, we had nothing to aim for. We had to ensure that everyone knew that the House was serious about tackling such infections. I firmly believe that progress is being made. I shall be watching carefully the hand-washing techniques of fellow Members of Parliament; although I will only be able to do so in the ladies' facilities of the House of Commons, it would be helpful if the chaps watched each other as well.

Ann Widdecombe: I was exceedingly disappointed by the Secretary of State's response to the motion. I consider that the NHS today has a tremendous problem. It does not much matter whether it is lesser, greater or co-extensive with the problem that might have been prevailing before 1997. The fact is that there is a problem, and it must be tackled.
	The Secretary of State's speech, however, was entirely defensive, and consisted of little more than comparative statistics. That attitude even prevailed when the hon. Member for North Norfolk (Norman Lamb) gave an interesting example of practice in the Netherlands, which was of considerable significance to the debate. The Secretary of State's immediate response was not, "That is very interesting. I will have that looked at", or, "Oh yes, that has already been considered and we do it in some of our hospitals." It was, "Ah, but the Netherlands has a 7 per cent. infection rate, and we have an 8 per cent. infection rate, so it doesn't really matter." When we raised the issue of uniform policy, we did not get an answer; our point was merely characterised as the central plank of Opposition policy to deal with MRSA and C. difficile, instead of being treated on its merits, not as the solution but as a contribution to the solution of the problem in front of us.
	In many ways, I was reluctant to participate in this debate, because no Member of the House ever wants to do anything other than praise their local hospital. When they have to do the opposite, they tend to feel cheated and a bit unhappy. But I cannot today pretend that all is well in Maidstone hospital, which has MRSA and, much more worryingly, C. difficile. I believe that various factors are contributing to the hospital not being able to control that problem as soon as should be possible.
	I often think that we treat foot and mouth disease far more seriously than we treat C. difficile. If foot and mouth disease breaks out, whole areas are isolated, troughs are set up, people disinfect themselves down to their boots, and great care is taken to ensure that nothing can come out of the zone into any other.

Crispin Blunt: Quite right too.

Ann Widdecombe: As my hon. Friend says from a sedentary position, that is quite right too. I was not trying to deplore the measures that we take over foot and mouth; I merely wanted to translate them into the measures that we take with C. difficile and MRSA, and to suggest that we could be a little more focused.
	Certain things could be done, which are only being done patchily in the NHS, that should be standard practice. One of those is screening. The hon. Member for North Norfolk was absolutely right: screening is important.
	I have a tale of three hospitals. They are my own hospital, Maidstone, to which I am utterly devoted and for which I shall always fight but which, on this occasion, is causing me anxiety; the Royal London hospital in Whitechapel, London, to which my mother was recently admitted as a trauma case; and King Edward VII's hospital, a private-sector hospital also in London, to which she was transferred when the trauma had been stabilised. I watched the way in which those hospitals operated.
	When my mother went into King Edward VII's hospital, the reaction was immediate. A swab for MRSA had to be taken straight away. It was not a case of whether MRSA had been present in the Royal London. There could be no argument: she was coming into the hospital, and therefore needed a swab. For the 48 hours that elapsed before the swab proved negative, she was barrier-nursed. Everyone wore aprons and gloves and underwent a disinfecting procedure before daring to leave the ward, even if they went out merely to fetch a pen or some hospital gadget. If they walked out of the ward, full disinfecting procedures took place as if it were a foot and mouth area. That is effective screening. When the negativity of the swab had been established, the barrier nursing ended and ordinary nursing was substituted.
	In the Royal London the floor was so clean that you could see your face in it, and the nursing on the Helen Raphael ward was exemplary. I should add that it was an old-style Nightingale ward. The nurses sat at a desk at the end: they could see every single patient, and every single patient could see every single nurse. Everyone knew what everyone else was doing. The ward did not have those wretched little rooms behind the desk into which nurses often disappear, and from which they emerge very quickly when people come to look at the wards. It was a very disciplined, busy set-up. I think that discipline and nursing standards are crucial.
	The hon. Member for Crawley (Laura Moffatt) referred to "ward managers", but it is the ward sister who should be responsible for discipline on the wards. In Maidstone hospital, old people's drips are running out and not being replaced. Food is being put in front of old people and taken away again without any attempt being made to ensure that they eat it. Pills are being found in the dressing-gown pockets of patients because they have simply been handed over rather than being administered with supervision. There is some extremely sloppy nursing, and it is therefore not surprising that there is also infection.
	One patient sent me a video showing the amount of dirt in some of the wards. Before any Member puts his or her hand up and mentions contract cleaning, I should say that one example of that dirt consisted of a bowl of blood that had sat on a window sill for nearly 24 hours. It was not a contract cleaner's job to pick that up; it was, crucially, a nurse's job. It was the ward sister's job to notice that it had not been picked up, and her job to ask "Why is that drip not being filled?" or "Why is that patient not being fed?"
	One of my constituents telephoned his brother to say that he was in Maidstone hospital with C. difficile, sitting in his own diarrhoea, and that he wished he was dead. Can anyone believe that when that is the standard of nursing, it has nothing to do with the spread of infection?
	Screening is important, discipline is important, standards of nursing are important, and the ward sister's role is important. She is not a commissioner of blankets and bandages; she should be exercising discipline on the wards. The role of visitors is also crucial. The hon. Member for Crawley told the story of the seven-year-old girl who went off to the loo. Was she not challenged, either going or coming back? Did no one ask "Have you washed your hands?", or say "You will make sure that you wash your hands, won't you?" Was she challenged by any of the nurses, by the ward sister or by any passing bearer of tea and coffee?

Laura Moffatt: As a nurse, I am probably much harder on, and less tolerant of poor nursing care than most others. In fact, I can get very angry about it, but does the right hon. Lady agree that, thankfully, due to the extra nurses working in the NHS, poor nurses are still a minority? From her speech, the House would think that a majority of care was being delivered in that poor way.

Ann Widdecombe: That standard of nursing is far too common across the NHS. I accept that it is not apparent in every ward. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley), in his excellent introductory speech, pointed out that we can have two adjacent wards, one with no problem and one with a problem, and two completely different sets of practices. That is why I mention the ward sister. The ward sister and individual discipline on wards are utterly crucial.
	If it were simply Maidstone, I would say that something has gone badly wrong at that hospital, which clearly it has, but I get letters from all over the country from people who have similar experiences to tell about their local hospitals. While I would not dream of saying that it is so everywhere, it is certainly so in a greater number of places than it ought to be. Screening, hygiene, discipline, challenging of visitors, proper disinfection processes—those are not rocket science. They all make a tremendous difference to whether infection grows, or is contained and eventually reduced.
	No one blames the Government for the fact that C.difficile exists. It is not their fault. It is not the NHS's fault. It is not any individual hospital's fault when it suddenly occurs, but the reaction to it is the responsibility of Government, the NHS and the individual wards, and that reaction is not all that it should be. It should be standard practice that a swab be taken from every admission to the NHS. I know that it is boring but it should be done once a person is admitted to the wards. Full-barrier nursing should be provided until the swab has been shown to be negative. Care in isolation should be provided if the swab is positive. However difficult that may be, and it would be, I do not deny it, that should be standard practice—it should already be standard practice.
	It worries me—I think Florence Nightingale would have had a bit of a fit—that now one has to remind medical staff to wash their hands. It should be absolutely second nature. They should wash them more often. Most of us have observed medical staff moving from bed to bed, coming and going from wards and, not always, perhaps not even for the majority of time but quite enough of the time, forgetting to wash their hands. That is not rocket science either. Therefore, if common sense were applied instead of statistics, we could make a serious difference, at not particularly great cost, possibly at rather a lot of inconvenience, but it would be worth it.
	I have had elderly patients die in Maidstone hospital who probably need not have died, whose relatives cannot forget what they saw. I have had recounted specific descriptions, including an occasion when a patient, and it was observed, rang a bell in the middle of the night for 15 minutes and was not answered because all the nurses on the ward were at coffee break at once. Rocket science? Discipline and the ward sister.

Michael Penning: It is a privilege to follow my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe), who spoke so much common sense. We have had an interesting debate, and I do not want to dwell on statistics and bore Members by talking about numbers. However, I desperately want to look at one area. In common with many Members, constituents of mine have died from MRSA—methicillin-resistant Staphylococcus aureus—and C. difficile in local hospitals, but I want to talk about the many patients who have not died, but who have suffered what they almost feel is a worse outcome, that of losing their legs.
	Let me give the example of a constituent I met shortly after the last general election. The gentleman had been involved in a serious car crash and he had extensive neck, head and shoulder injuries, but he had no problems at all with his legs. He had steel plates inserted in theatre and was in intensive care for a considerable period. When he went on to the wards to recover, he was tested for MRSA; he was found to have it and subsequently lost both of his legs. That highlights the daily effects of having that kind of infection in our hospitals. Like my right hon. Friend, I do not blame the Government for the existence of such infections—I do not think that anybody would dream of doing so—but what is important is how we react to this situation.
	I have a question for the Minister—have any modelling or other studies been done on the effects of contract cleaning and in-house cleaning? As the Minister knows, I am a trade unionist, and the point contained in my question is often thrown up by Unison and other such bodies representing their workers. Their representatives say, "The problems arise because we have contract cleaning." I am a member of the Health Committee, and in that capacity I have visited hospitals using contract cleaners that are immaculately clean and hospitals cleaned in-house that are also immaculate; but, frankly, in my area of Hertfordshire there are also filthy hospitals that are cleaned by contract cleaners and filthy hospitals that are cleaned by in-house cleaners. It must be the job of the Secretary of State and her Department to set standards so that the whole country is on a level playing field. Like many Members, I was disappointed to hear this afternoon the Secretary of State yet again avoid responsibility.

Nadine Dorries: In my day—I hate saying that, as I use that phrase so many times in talking about this subject—we had ward sisters and staff nurses, and we used to go into kitchens, check under the beds and check the headboards and bedside cabinets and tables, and if we were unhappy we would get the cleaners straight back in to clean again, because our word was law. That is not the case nowadays. The ward sister is not even allowed to speak to a cleaner and, besides, many hospitals do not even wet-mop any longer. Therefore, the management of the staff is what is important.

Michael Penning: My hon. Friend is a former nurse and she brings a whole education to this House in terms of understanding what goes on in hospitals. My mother was a nurse for 40 years. Florence Nightingale might be turning in her grave, but my mother turns incessantly because of nurses and doctors who do not do things such as wash their hands. I will come on to cleanliness and the mopping situation shortly.
	I want now to discuss an issue that my right hon. Friend referred to—discipline. I recently visited my hospital and I was introduced to a modern matron. I asked that modern matron what she did and she replied, "I manage." I inquired whether she managed a ward and she said, "No, no; I manage lists and things." That shows why the Government's target culture is so wrong and why targets should be abolished. Instead, standards should be set throughout the NHS for what is right and what is wrong—what is good practice and what is bad practice.
	Let me give the Minister a prime example of good practice across the board combined with discipline that is working very well. If the Minister were as lucky as I am, he would have had the pleasure of visiting the field ambulance unit in al-Amara in Iraq. It is made up of regulars from the Royal Army Medical Corps and other services, but also of Territorial Army members of our armed forces, of whom we should be very proud for augmenting our forces. Most of those TA members are doctors, nurses and technicians who have come from the NHS. They work in the NHS in everyday life, but they are currently in Iraq serving our armed forces.
	The Minister can correct me if I am wrong, but in the three years that that field ambulance unit has been in place, there has been not a single case of MRSA among our armed forces there, nor among those of the local population who were treated there when they needed acute care. Why is that? Part of the explanation is clearly that the bed occupancy rate is very low. Patients are not being rushed into a bed within minutes—sometimes, it literally is minutes—of its being vacated. Also, cleanliness is the responsibility of the ward sister and of the nurses in that field hospital. Those same nurses also work for our NHS in this country. I have met them and they want to provide the best possible care; they want to put a rocket up cleaners who are not doing their job, but they are not allowed to. However, when they are working in the military, they naturally have the backing of rank and of the armed forces. As we have heard so many times today, keeping our wards clean daily is not rocket science.
	Many years ago—it must have been 1972, given that I joined the Army in 1974—I volunteered to work on Saturdays on the geriatric unit, as it was called in those days, that my mother worked on in the Rochford hospital in Essex. I saw nearly every Saturday what we would now call spring cleaning—the hospital called it Saturday cleaning—where nurses and cleaners worked together and blitzed the ward. Patients who could leave their beds did so, and everything was cleaned until it was spotless. I cannot remember the last time I saw a nurse do that sort of cleaning. That is not because they do not want to—by the way, if it is, they should do it anyway—but because of the pressures in the NHS today and the different nursing methodologies, which simply involve passing the drugs around, for example. It is not that our NHS does not care. Far be it from anyone in this House to say that people join the NHS for any reason other than to serve their communities; they certainly do not do it for the money. They do it because they care, but bit by bit, the view that the patient must come first and bureaucracy second is somehow being knocked out of them.

Ann Widdecombe: Has my hon. Friend observed, as I have, that on going into NHS hospitals nowadays, one sees armies of people with clipboards? That is the culture that is depressing real effort and enthusiasm.

Michael Penning: I could not agree more with my right hon. Friend. In my armed forces days, those who walked around with a clipboard were usually left alone because they were not doing anything. We do not want people with clipboards; what we need is for wards and beds to be cleaned efficiently, so that we can get to grips not only with MRSA, but with C. difficile and other infections. Given the information in the Government's leaked documents, there is no doubt that through targeting just MRSA, efforts to deal with other dangerous and critical infections have unintentionally fallen by the wayside. I do not think that the Department said, "We'll let C. difficile explode out of all proportion,", but it took its eye off the ball by going down the avenue of targets. As the experience of my local hospital structure shows, if one thing is targeted, something else gets forgotten because the system simply does not have the capacity to cope.
	I shall not dwell on what I saw in my hospital the Friday before last, when I visited a friend who has since sadly died, but I will point out that I saw a ward full to bursting and a mixed-sex ward. That, in the 21st century, is degrading, and the Government promised that it would not happen. No more than 20 ft from the ward that I visited was another ward that was empty not because it was infected, but because there is no money to staff and run it. Frankly, the south-east gets a particularly bum deal when it comes to NHS funding. The Secretary of State knows, because I go on and on about it, that this is an issue in my general hospital, which is about to be closed. I will defend that hospital and its nurses to the hilt. We have to have the capacity that allows cleaning to take place in the short period during which beds can be cleaned properly, for example.
	My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries), who probably has much more experience in nursing than all the Government Front Benchers put together, raised the very important issue of wet-mopping, which we used to call "grind it into the ground" mopping. I do not know whether anybody has noticed this, but wards tend to be rectangular—they have corners. However, the cleaning process involves the use of circular electric mops that cannot get into the corners. Bit by bit, the dirt and muck gets thrown into the corners, and unless someone is willing to get on their hands and knees, the dirt will not be cleaned out. When wet-mopping was done, that was not a problem because mops can get into the corners. Of course, even with wet-mopping people could be complacent and not use hot water or the right chemicals, but at least it was possible to see what was going on; now, often it is not.
	Has there been any indication of the cost to the NHS of litigation arising from cases of hospital-acquired infections? The Minister said that the Government recently invested £50 million to help deal with hospital-acquired infections, £45 million of which will be used immediately. I should be interested to know whether any of that has gone to West Hertfordshire Hospitals NHS Trust. I should be very surprised if it has, but perhaps he could write to me and let me know. The cases where those who have acquired these infections have gone down the litigation route must be costing the NHS an absolute fortune. In the long run, it must be cheaper, and morally and ethically preferable, to clean the wards properly rather than paying lawyers a fortune.

Anne Main: My hon. Friend's constituents and my constituents often use the same facilities; indeed, many of my constituents go to the Hemel Hempstead hospital. On management of rates of infection, I am sure that he shares my concern at the following report, which said:
	"Mandatory staff training is included for staff at induction, but all staff groups are not always covered and training of doctors remains a challenge as does infection control standards in relation to outside contractors."
	I agree with my hon. Friend that cleaning implements may be contributing to the problem, but so are training and a failure to keep track of those in an outside capacity who come into hospitals, as he said earlier.

Michael Penning: My hon. Friend's knowledge of health provision issues in south-west Hertfordshire is well known, and she raises an important issue. As the hon. Member for Crawley (Laura Moffatt) also said, we should not simply concentrate on what the nurses should be doing; we must also consider the other hospital professionals, especially the doctors and consultants, who have their own problems. In my experience of sisters running wards, if a consultant turned up with a dirty coat, for example, they would grab him by the ear and sort him in out in 20 seconds flat.
	My hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) had an Adjournment debate recently in which he raised the issue of C. difficile, which is a frightening infection. It cannot simply be treated at the bedside with gel; unless it is attacked at its core, treatment will make no difference. In fact, it thrives in such environments. We need to appreciate the levels of hygiene and the standards that will have to be applied across the NHS in dealing with that issue. If the Minister does not have the powers to enforce the cleaning standards that he is looking for, I am sure that my Front-Bench colleagues will help him to obtain them.
	The country is sick and tired of an extremely well paid Secretary of State saying to this House and in TV broadcasts around the country, "It's nothing to do with me." The buck stops with the Secretary of State. Yet again, we have heard at the Dispatch Box today that—

Andy Burnham: Will the hon. Gentleman give way?

Michael Penning: No, I shall not give way. If the Minister does not like what I have been saying, he can address that in the wind-ups.
	At the end of the day, the Secretary of State is responsible for health care in this country. That is what she is paid an awful lot of money for, and many people are disappointed with the level of treatment that we are getting.

Bill Wiggin: I am delighted to have the opportunity to speak in this debate because Hereford hospital, which serves many of my constituents, has had a good record—though not perfect—in recent years with hospital infections. In 2004 it had the lowest rate of MRSA detected in hospitals. Between April and September 2005 there were 13 cases of MRSA, and I am pleased to report that between March and October 2006 only 12 cases were diagnosed in Hereford hospital, and 10 of those had had the infection before being admitted. Hereford hospital also does quite well in controlling Clostridium difficile, with an infection rate of 1.12 per 1,000 bed days for patients aged 65 and over. In the March to October 2006 period, there was only one case reported.
	I know that the Hereford Hospitals NHS Trust's chairman, Cessa Moore, and the new chief executive, Martin Woodford, have wisely given infection control a high priority. The hospital has a dedicated infection team that promotes cleanliness and personal hygiene. It also regularly updates its education programme. I am confident that the efforts of the hard-working staff and the hospital's management are keeping superbug outbreaks low. On the Healthcare Commission's core standards assessment form, the hospital is compliant with requirement C4a, which requires that
	"Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in MRSA".
	My three children were born at Hereford, by caesarean, and I have always felt that my wife and family were safe there.
	Despite the hospital's good record, the excellent work of the staff and praise from its users, the Government have decided to tie its hands behind its back and starve it of resources. Earlier this month, the Secretary of State refused its application for foundation status. The primary care trust budget was also top-sliced to prop up PCTs with financial failings elsewhere in the vast area covered by the strategic health authority. With those actions, the Government have undermined our efforts to manage the dangers posed by superbugs and are letting down NHS staff and patients. While I have every confidence in the abilities of staff and the management team in Hereford, I have little confidence in the Government's support for them. Labour has made a mess of governing the NHS, and superbugs may well end up as another unwanted part of the Prime Minister's legacy.
	Every individual case of MRSA or C. difficile is a personal tragedy for those infected, and my constituents have a growing fear of the problem.

Andy Burnham: Will the hon. Gentleman share with the House the percentage increase in MRSA between 1990 and 1997?

Bill Wiggin: It was clear from my opening comments that I gave the figures as accurately and as helpfully to the Government as I could. I am sorry that the Minister was not paying attention. It is difficult to make progress in such debates when although we try to be positive about what is happening, requests for foundation status are turned down. How can the Minister possibly try to score political points when he has gone out of his way to sabotage the one thing that my hospital wanted most? If he wishes to intervene again, I shall be happy to listen to any more ridiculous attempts to whitewash this Government's disgraceful legacy on the NHS.
	Fears have been heightened because this month both MRSA and C. difficile have featured in the news. In Nottingham 30 deaths have been linked to C. difficile since November, and in the last couple of days it was reported that specialist teams will be brought in to fight MRSA in two hospitals in the west midlands—the Princess Royal in Telford and the Royal Shrewsbury. Because of the fears and concerns about the reporting of superbugs, last month, the Hereford hospital patient and public involvement in health forum took it upon itself to monitor the situation on the ground and carry out regular cleanliness visits.

John Pugh: The hon. Gentleman mentions heightening fears, but during the 2005 election the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) wrote to my constituents suggesting that the MRSA rate was 10 times higher than it actually was, and the local hospital demanded an apology. Would he care to comment on that as an example of how fears can be heightened unnecessarily by the political process?

Bill Wiggin: I was expecting that sort of intervention from Labour Members. People are fearful because they do not know what is going on. When we try to draw attention to what is happening, we are told that our figures are wrong. In my experience, it is hard to discover the correct figures. Tremendous pressure has been put on NHS staff to produce figures that suit the Government, especially around election time. I suggest that the hon. Gentleman checks more carefully before accusing my right hon. Friends of misleading his constituents.

Stewart Jackson: My hon. Friend makes a powerful argument on behalf of his constituents. Does he agree that the Government's policy is marked by duplicity? On the one hand, they praise NHS staff and set them arbitrary targets to tackle MRSA and C. difficile, but on the other they issue secret memos to high-ranking civil servants saying that it is impossible to meet those targets and that the NHS might as well give up now. Is not that a duplicitous way to approach governing the NHS?

Bill Wiggin: My hon. Friend makes an excellent point, as always. He is right to be worried about the issue. It is our job to draw attention to the facts and not to be swayed by exaggeration, or to be convinced by the Government that everything is all right when it is not—

John Pugh: Will the hon. Gentleman give way?

Bill Wiggin: No. I have given way to the hon. Gentleman once, and it is only fair that I try to make a little progress, as I am coming to an issue related to his earlier intervention.
	We must also investigate superbugs transparently and honestly at both local and national levels; and that is why it is essential that the Government come twice a year to the House to report on the action that they are taking. Because of the NHS financial crisis created by the Government and the growth in superbugs, public confidence in the NHS needs to be restored. We know that virulent strains of MRSA can resist even the strongest antibiotics, but we also know that scientific developments and technologies are continually moving forward. What our constituents want to know is how well the Government and NHS are adapting to those changes and how new scientific and technological advances and new cleaning techniques are being applied in practice.
	Only last week, microbiology specialists Oxoid developed a new test to detect C. difficile-associated diseases. It can be carried out in about 20 minutes and could make a huge difference in combating C. difficile, because of its ability to detect the disease early. That should be given serious consideration, along with the "search and destroy" pilot strategy promoted in this motion, because it will save lives.
	The Government's own adviser on health protection has conceded that in the current circumstances the Government's target to cut MRSA bloodstream infections by half by 2008 will not be met. It has also been admitted that C. difficile is widespread and much harder to deal with than MRSA. New approaches are needed, and a six-monthly report to the House would enable hon. Members to debate this important issue and hold Ministers to account for their actions.
	Those terrible infections can strike down anyone, but they hit the most vulnerable the hardest. In Herefordshire a quarter of the population is over 60, and the number of people of 85 and over will increase by 43 per cent. between 2004 and 2011. Many of them are currently in need of regular in-patient hospital care—or are likely to be so in the future—and the NHS and the Government have a duty of care to ensure that the chances of superbug infection are kept to an absolute minimum. My constituents should be able to go into hospital, receive treatment and leave feeling better; they should not leave after suffering the ordeal of such an infection. We have to wage war on those diseases, but we are unlikely to win with this Government in charge of the NHS.

Daniel Kawczynski: It is a great pleasure to follow my hon. Friend the Member for Leominster (Bill Wiggin), and I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on securing this very important debate.
	At the outset, I want to say that the staff of the Royal Shrewsbury hospital do a tremendous job in very challenging circumstances. The socialists always criticise Opposition Members when we raise these matters— [ Interruption. ] Well, I think that they are socialists. They claim that we are trying to denigrate the NHS, or the people who work in it, but that is not true.
	I am a great supporter of everyone who works at the RSH, about which the House will know that I feel very strongly. It is my No. 1 priority as the local MP, and I am running the London marathon in April on behalf of its league of friends, a charity that raises money to buy vital equipment that should be provided by this socialist Government. I am not particularly fit, but I hope to finish the 26 miles and raise as much money as possible. If anyone wants to sponsor me, I should be grateful.

Bill Wiggin: I have every confidence that my hon. Friend will do considerably better than I did in the London marathon, when I set the record for the slowest time ever achieved by any MP. I wish him very well, and I hope that he raises a lot of money. What a shame it is that he has to use the funds that he raises to fill spending gaps left by the Government.

Daniel Kawczynski: I thank my hon. Friend, and totally concur with what he says.
	This debate is about MRSA. A leading campaigner on this issue in Shrewsbury is a lady by the name of Pat Davies. The Minister should get in touch with her, as she has spent many decades in the nursing profession and has dedicated her life to caring for people. She lives in Copthorne, near the RSH, and regularly comes to see me to tell me about current problems in the NHS. I want to raise with the Minister some of the matters that she has brought to my attention. Sometimes politicians—especially socialist ones—think that they know everything, and do not need to listen to people with great experience who have worked at the coal face for years.

Caroline Flint: Coal face!

Daniel Kawczynski: The other Minister of State who is present, the hon. Member for Don Valley (Caroline Flint), is barracking me from a sedentary position, as is her custom. Surely we should listen to our constituents, especially when they have long experience of working in the NHS.
	Mrs. Davies has offered me a number of suggestions, which I want to pass on to the Minister who will wind up the debate. First, no indoor uniform should be worn outside the hospital. Changing facilities should be provided, and that strict rule must be adhered to. Secondly, nurses should be made to wear a disposable apron when in contact with patients. That is the practice in Europe, so why not here? It is obvious that disposable aprons should be used when a nurse comes into contact with a patient, and then disposed of immediately afterwards.
	Thirdly, Mrs. Davies says that spot checks on thick uniforms should be carried out, to find out what types of bacteria are growing there. In addition, doctors should wear white coats over their suits. Fourthly, visitors should be supervised, and they should not be allowed to sit on beds. There should be no more than two visitors to a bed, and patients should not sit on other patients' beds.
	When I was recently in the Royal Shrewsbury hospital's maternity unit awaiting the birth of my first child, Alexis, I saw an awful lot of people sitting on beds, and there were far more than two visitors per patient. I mean no criticism of the hospital: the nurses are so overstretched that they do not want to keep going on about people sitting on beds. It is something that the Government should communicate to the general public. The Government spend millions of pounds on putting socialist propaganda on television, which they say is public information—but why do they not talk about MRSA, or other important matters? They should tell people that they have a responsibility to act correctly when they visit relatives in hospital.
	Mrs. Davies' fifth point is that paper carries infections, so patients should not share newspapers or magazines. She is right about that, but the maternity ward was full of magazines that people passed around. There should be much stricter guidance about newspapers and magazines in hospitals, as Mrs. Davies assures me that MRSA can be carried by paper.
	Mrs. Davies' final point has to do with cleaning, and the need for wards to have domestic supervisors. When wards are cleaned, the clutter that gathers around beds is not moved, but that problem could be overcome if a ward sister were on hand. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) has often spoken about the need to have matrons or ward sisters in hospitals, and the Minister should take heed.
	The RSH is more than £30 million in debt, as the Minister will know. People are very worried about the focus on debt reduction, and the problem is now so bad that charges for car parking are not confined to members of the public who use the hospital. Under this socialist Administration, nurses are being told that they will have to pay to park their cars when they come into work —[ Interruption. ] The Minister may laugh, but that is the reality.
	The hospital has set up all sorts of schemes to raise money to deal with the debt. Charging nurses to park their cars is one such scheme, but another is to charge the hospital's league of friends for operating its charity shops in the hospital. I and other Shropshire MPs have regular meetings with the hospital's chief executive, Tom Taylor, and the focus is always on finance and how the huge debt can be reduced. That approach worries me, because it lessens the attention given to problems such as MRSA.
	When my daughter Alexis was born—on Trafalgar day—I was extremely impressed with the cleanliness of the RSH's maternity ward. However, the staff are very overstretched, and although I shall not go into the details now, I would be happy to write to the Minister about what I saw in the three days that I spent waiting for my child to be born.
	As I noted in an intervention on the hon. Member for North Norfolk (Norman Lamb), 16 beds are to be cut at the RSH maternity ward between now and February. On top of that, the hospital in nearby Oswestry is to lose its maternity services completely. As a result, there will be even greater pressure on the RSH's maternity services. I fear that the cuts mean that people will take their eye off the ball, and the high standards of our maternity services will not be maintained.
	All those things are part and parcel of the Government's attempts to take a one-size-fits-all approach to maternity services. In Shrewsbury a woman stays in hospital after giving birth for 2.6 days, on average. The hospital has won so many national awards that staff are repeatedly asked to come to the House of Commons to give evidence to the Health Committee about their great achievements, yet outside consultants have now told them that a stay of 2.6 days is far too long, and that they should aim for the national average of one day. That is a scandal. I am concerned about that situation, and about the impact of the cuts on dealing with MRSA.

Nadine Dorries: It is especially fascinating to listen to the Secretary of State talking about MRSA. She talks about headline figures, targets, strategies and meetings, yet never once does she answer a question that relates directly to the problem or discuss it in practical terms.
	We know that some hospitals do not have MRSA. There is little incidence in the private sector. Hospitals in Scotland have a low incidence. Field hospitals in Iraq and military hospitals have no MRSA. There are hospitals where MRSA does not occur, yet we seem unable to transfer their example to the national picture to deal with what is happening in hospitals with bad records.
	It is not difficult to keep a hospital ward clean. I shall go through a few measures that I know make a huge difference to cleanliness on wards. We have already talked about ward sisters; the line of command is important. When I was training, we did not merely go on to a ward—we went on to Sister Jones's ward or Sister Smith's ward. Their ward was their fiefdom, where they were in charge. There was competition between sisters; Sister Jones would never in a million years want her ward considered less clean than Sister Smith's ward.
	Huge emphasis was put on the internal cleaning of wards. A large part of the job of nursing auxiliaries was cleaning—washing down beds, cleaning out cupboards, cleaning window sills, wiping down chairs and making sure the ward looked immaculate. That no longer happens to anything like the same extent.
	I became aware of how far standards had slipped when I visited my grandfather in hospital recently. I found him sitting on a chair next to his bed. He was cold, because he was not wearing pyjama bottoms—I will not go into details, but it was a sorry sight. The ward floor was dirty. The bedside table was dirty; food had been left on it for days. Nobody took enough care. Nobody was worried about the cleanliness of the ward, yet the hospital has a high incidence of MRSA. It was obvious that the incidence could have been reduced by making the wards cleaner.

Charles Walker: Does my hon. Friend think that hospital chief executives spend enough time on the wards? Any chief executive worth his salt would be appalled at the conditions that she found and would not allow them. Perhaps the wrong type of people are at the top of our hospitals. Such things would not happen in the private sector.

Nadine Dorries: My hon. Friend is right. Many chief executives rarely go on to the wards, although the chief executive of my local hospital does. However, when I visited the hospital recently nurses told me that it was an unusual occurrence in other hospitals where they had worked, if it even happened at all.
	Visiting used to be limited in hospitals. There would be a couple of hours in the afternoon and again in the evening, which restricted the amount of outside traffic into the wards, allowing them to be cleaned properly. Now we have open visiting, all day and all night. Families come into the wards, sitting on beds and by bedsides. The ward doors are never closed, so there is no proper cleaning.
	People constantly have to deal with visitors. On a recent visit to a ward, as the MP, I was standing behind the nurses' station and visitors thought I would know where various people were. People constantly came to the nurses' station asking questions. That used not to happen because visitors were allowed only for a few hours in the afternoons and evenings so that wards could be cleaned properly.

Stewart Jackson: Does my hon. Friend agree that another associated problem, which was raised by our hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), is the over-prescription of antibiotics because hospital staff are so overstretched? They cannot consider individual cases properly because they do not have enough time or resources to do so.

Nadine Dorries: Indeed. The problem is wide-ranging and often arises from the over-prescription of antibiotics in the primary care sector before patients are admitted to hospital.
	The solution is not just keeping hospital wards clean. It involves the end of hot bedding. Several Members have described how immediately after one patient has been discharged another one comes straight in before the bed is cold. The bed and the whole area around it should be cleaned and sterilised, but the targets mean that people are in and out before the cleaning can be done. The ward is not wet-mopped; it is merely dry-mopped with a big electric cleaner that cannot remove sticky substances or spillages.

Robert Goodwill: Is my hon. Friend aware that in many German hospitals once beds are vacated they are sent to a cleaning station in the basement, where they are cleaned and shrink-wrapped before being sent back to the ward? Would not such a practice address some of our hot-bedding problems in British hospitals?

Nadine Dorries: My hon. Friend makes an important point. Some UK hospitals have such facilities, although they may or may not be in use. However, we would not need to use such methods if nurses did not wear their uniforms to work—an issue I have previously raised in Committee.
	In supermarkets, we see nurses in uniform leaning over the fruit and vegetable counter with a toddler sitting on their hip. Are those nurses on their way to work or on their way home? If they are on the way to work, what bacteria are they carrying from the toddler on their hip or the supermarket vegetable counter to the hospital environment? Nurses should change into uniform when they get to work. When I was a nurse, I used to go to the hospital basement, give my name and then be handed my uniform, which was on a big rotating rack. I would go to the locker room, get changed and go on to the ward. When I finished work, I would change and put my uniform into a dirty uniform holder. I would never have dreamed of wearing my uniform home or back to work. I did not want to take bacteria from the hospital home to my children. It was a two-way process.
	If there were laundries in hospitals we would not need to spend so much on dealing with MRSA in hospital. Measures such as shrink-wrapped beds might not even be needed if we implemented basic procedures. Laundering of uniforms is one of the most important measures, and the lack of it is one of the biggest contributors to the rise of MRSA.
	Specialist equipment is available. Recently, I received information about an air-change instrument that removes bacteria from the air. When I visited a hospital ward not long ago, there were no alcohol wipes with which visitors or patients could wipe their hands. There was a dispenser on the wall, but the person I was with told me it had been empty for two days. There should be a procedure to ensure that alcohol hand-rubs are replaced every day, and a ward sister to ensure that the procedure is followed.
	My hon. Friend the Member for Hemel Hempstead (Mike Penning) rightly spoke of the value of ward sisters in military hospitals in Iraq. Rank plays a part. If the wards are not clean, the ward sister calls the cleaner back. That is exactly what used to happen in our hospitals. The ward sister's word was law. If a doctor was not wearing his white coat, he would be sent to get one before he was allowed on to the ward. We need authority on the wards—and it can come only from ward sisters, which is why we need to take hospital cleaning back in house, back under the control of the wards and the ward sisters.
	To conclude, as well as ward sisters, we need auxiliary nurses back—nurses who take pride in cleaning and take responsibility for it on the wards. If the wards were basically kept fundamentally clean, we would not have MRSA.

Andrew Murrison: It is extraordinary, is it not, that of all debates, this one on health issues is the one with just one Labour Back Bencher turning up to make a contribution. The Secretary of State was at pains to explain that this issue was her No. 1 priority, but it does not seem like that to me—and I have to tell Government Front Benchers that it will not seem like that to people watching today's debate or reading accounts of it. I hope that the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), will explain in his winding-up speech how it is that just one Labour Back Bencher has spoken on such an important issue.
	One in 10 in-patients will acquire an infection in UK hospitals. In 2004, there were 1,300 deaths resulting from C. difficile alone, as a result of which people worry about going to hospital. Anyone doubting that needed only to attend, as I did, a recent meeting convened by the MRSA and C. diff support group in Portcullis House. A range of harrowing tales was told by members of that group about their experiences and their concerns about this important group of infections. I recommend that the Minister listen very carefully indeed to those accounts and experiences.
	My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friends the Members for Hemel Hempstead (Mike Penning) and for Mid-Bedfordshire (Mrs. Dorries) did some comparing and contrasting between our attitude towards health care-acquired infection and foot and mouth, between command and control in the NHS and military hospitals in Iraq, and between hospitals of which they had first-hand experience. All three supported discipline in the NHS and I suspect that my right hon. Friend the Member for Maidstone and The Weald would endorse the Royal College of Nursing wipe-it-out 10-point plan on MRSA, which clearly states:
	"Employers should be mandated to introduce straightforward, confidential and highly visible systems which allow patients, visitors and staff to report safely and/or challenge poor practice, incidents and mistakes involving infection control and cleanliness."
	I am sure that she would agree with all that.
	The cost to the NHS of health care-acquired infections is more than £1 billion annually. That approximates to the NHS deficit, which today—no, tomorrow, as it has been delayed—prompts the Wiltshire primary care trust to announce the closure of community hospitals in my constituency. When set in that sort of context, one realises the enormity of the problem faced by the NHS right now—and the scope for remedial action and what that might mean at ground level. It would certainly mean a great deal to my constituents as they face the closure of their community hospitals.
	Indeed, the true cost may be even greater, as we have very little idea of the amount of wound infections that stop short of bacteraemia. Estimates suggest that the true incidence of MRSA is in fact 10 times the official figures. MRSA grabs the headlines, but the real menace right now appears to be Clostridium difficile, which has proved refractory to most of the initiatives that Ministers have launched on health care-acquired infections.
	At the centre of the Government's efforts is the "Clean your hands" campaign, but the Healthcare Commission does not think much of it. It pointed out that compliance was poor last year and revealed that more than a third of trusts were not providing the basics necessary for hygiene—hot water, paper towels and alcohol rubs. It said that 50 per cent. of staff had no training in hygiene in the preceding year. Little wonder that we are not making much progress.
	In health care there is only one thing worse than a target—and that is a target that is not being met. It is now clear that the November 2004 MRSA target will not be met. The famous leaked memo tells us that very clearly, but more revealingly still, that memo is largely given over to how an inconvenient truth might be dished up and presented to the public, whom I imagine Ministers consider to be gullible. Rather than present options for remedial action, it agonises over how fudging the target might be seen as a "cop-out" or, with remarkable frankness and extraordinary understatement, open to the "accusation of fiddling". This is a memo not from a "good day to bury bad news"-style subordinate, but from no less a person than Liz Woodeson who, as director of health protection, is at the very heart of the Government's strategy for public health.
	The memo speaks volumes about two things: the Government's failure to address MRSA and their obsession with spin over substance. So ineffectual have Ministers been that the Prime Minister's Delivery Unit has, we understand, stepped in and we await its report on what can be done, in the words of the Department of Health, to "galvanise action". Surely it is not too much to expect our record on hospital-acquired infections to approximate more closely to those of northern rather than eastern Europe.
	We learn that the Minister of State has been on a back-to-the-shop-floor initiative—a bit like Gerry Robinson. His quest is to find a solution to what the Prime Minister has characterised as the "dirty corridors" of the NHS. I hope he gained as much from his experience as I did from my experience as a member of the ancillary staff of a hospital in our national health service some years go, but I fear that he may have seen a great deal but learned very little. We hear that he wants trusts to do away with cleaning contractors. I wonder whether that is evidence-based medicine or an innovation in the lexicography of the NHS called "anecdote-based medicine". When the Healthcare Commission does its annual health checks, will it be expected to press for the latest whimsy of Ministers rather than standards grounded in the evidence?
	If the Minister can produce a body of evidence to support the contention that hospitals with contracted-out cleaning are worse than those with in-house cleaning, we would be more than happy to support him—but I do not think he can, so I am afraid we will not. What the Minister has not thought through is the fact that the big contracting-out that the Government introduced cannot simply be undone. Of course cleaning is contracted out in independent sector treatment centres and PFI projects—that is the whole point—but it is not clear how the Minister, if keen on bringing hospital cleaning in house, will govern these particular institutions and change their practice. If he is so keen on contracting out on a grand scale, why is he recanting when it comes to individual hospital trusts?

Charles Walker: Are we not in danger of over-complicating the issue? If Tesco had a store that was routinely filthy, it would fire the manager and hire a new manager who could ensure that the store was clean. Surely if a hospital trust is routinely filthy, we should fire the chief executive and hire one who can ensure that the hospital is clean and safe for the patients under his or her duty of care.

Andrew Murrison: My hon. Friend makes a very good point, which demonstrates the importance we attach to this issue. His remark underscores how important it is for us. It is a pity that Government Members do not think it at all important, as evidenced by the fact that only one of their Back Benchers managed to turn up to make a contribution.
	What account has the Minister taken of the hospital-acquired infection record of non-NHS hospitals, and are there any lessons to be learned from it? I make no particular judgment, but the record in some non-NHS hospitals is clearly better than in some NHS hospitals, so it would be foolish not to study it carefully and learn whatever lessons are to be learned. I would be interested to hear whether the Minister has reflected on the difference between the two and on what might be done to improve the record in the NHS as a result.
	I am quite convinced that what is actually important is that ward staff must be comfortable with the management tools to direct cleaning staff, that cleaning staff should feel that they are a full and valued part of the health care team and that senior nurses should have access to them 24/7. We often go around hospitals, and it seems to us that cleaning staff are not seen as full and active parts of the health care team—well, they are, and they must feel that they are—and I am very sorry that the Secretary of State's amendment eschews our mention of health care staff. That is a pity, and I hope that it is an oversight. Mention of ancillary staff is long overdue, and I hope that, in reparation, the Minister might mention their contribution to cleanliness in hospitals.  [ Interruption. ] If the hon. Member for Livingston (Mr. Devine) would like me to give way, I should be more than happy to hear his remarks.
	My hon. Friend the Member for Leominster (Bill Wiggin) is right to be concerned about innovation and the fact that it has been introduced far too slowly. The rapid review panel is apparently not rapid, according to a frustrated innovator, called Air Science, which has contacted a number of right hon. and hon. Members. It says that
	"it is ineffective in meeting its aims and by not encouraging further research of the most promising applications it is an obstacle to progress."
	The main block appears to be the rapid reaction panel's level 2 assessment, which involves the ability to gain support for the translational research and development which enable small companies of the sort that Air Science evidently is to front up the innovation that the health service needs to tackle health care-acquired infection. A level 2 innovation is promising, but crucially, has not yet been proven in an NHS hospital setting. Most companies struggle to afford the means to provide such proof and they need help with it. Air Science concludes by saying:
	"Clearly there is great scope for new initiatives. To find them was the intended role of the RRP. It is instead proving a barrier to progress, not its catalyst."
	The onward march of Clostridium difficile has underscored the need for restraint and discernment in the prescribing of antibiotics. Four times as many people die in the UK from that health care-acquired infection as from MRSA, and conventional cleaning and hand washing will not necessarily help that much—a different approach is needed. What is the Minister doing to ensure best practice in universally applying the lessons available from best performance in the NHS and to ensure that they are learned by outriders? It seems that he is doing precious little, judging by the absence of a reference to Clostridum difficile from the Government amendment.
	The hon. Member for North Norfolk (Norman Lamb) made a very valuable contribution. He rightly talked about antibiotics. He should also have talked about—we might have done as well—instrumentation that introduces infection, such as intravenous cannulation and other things, as that has been the subject of much debate recently and of comment by Professor Hajo Grundmann of the National Institute of Public Health in the Netherlands. It is very important that we consider minimising such interventions in our fight against health care-acquired infections.
	The Secretary of State for Health mounted a robust defence of the national MRSA target set in 2004, saying that, in its absence, less progress would have been made. Will the Minister say when he will set up a comparable target for Clostridium difficile, because that is the natural extension of what the Secretary of State said? The Secretary of State's defence of local targets was based on a false assertion that it is a local problem—well, it clearly is not, as is made very clear by the comment from her own Department that it is endemic.
	The hon. Member for Crawley (Laura Moffatt) and my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) rightly talked about staff. The Government amendment removes any mention of staff from our motion, which is a pity, and I hope the Minister will explain that. From the Royal College of Nursing 2005 "Working Well" survey, we learned that the number of nurses with access to changing facilities dropped from 61 per cent. in 2000 to 50 per cent. in 2005, and that only 39 per cent. of nurses have access to showering facilities at work. Just 35 per cent. of hospital-based NHS nurses said that their employer provides a uniform laundering service. Is that any way to treat a profession that is doing its utmost to reduce health care-acquired infections? What message does it give to those who are entering the profession about the significance attached by management to basic standards of hygiene?

Andy Burnham: I welcome today's debate, because it deals with an issue to which this ministerial team attaches the highest possible priority: patient safety and public confidence in our national health service. It gives us an opportunity to say very clearly on the record that MRSA infection is falling in our NHS, despite what others might seek to claim. However, there is absolutely no complacency whatsoever among Labour Members, and I will set out some of the measures that the Government are taking.
	While sitting through this debate, I have heard more bar-room garbage emanate from Opposition Members than perhaps I have ever heard before. Yesterday, they pledged to abolish targets and end top-down Government action in the NHS. [Hon. Members: "Hear, hear."] The call was to keep politicians out of health care and the NHS—a big, principled call. Today, they bring us to the House to demand no less than six-monthly reports on Government action to tackle health care-acquired infections. Yesterday, they committed themselves to scrapping our MRSA target. Today, they put before us what seems like a target for the number of washing machines in NHS trusts.

Bill Wiggin: I do not think that the Opposition should take any lessons from the Minister or the Government about keeping politicians out of the health service, when only one Labour Back Bencher can be bothered to make a speech.

Andy Burnham: The hon. Gentleman will hear me robustly defend the role of politicians in the crucial issue of public confidence, and he will get his answer. After hearing the utter the confusion among Opposition Members, those who work in the NHS are entitled to ask what the Opposition are proposing. Are they saying, "Trust the professionals", or are they suggesting that how many times they should wash their uniforms and where they should wear them should be subject to mandatory guidelines? That is the message that has come from Opposition Members all afternoon. I have sat here and I have heard it. They do not trust the professionals at all to do any of those things, and that rings out from those on the Opposition Benches.

Several hon. Members: rose—

Andy Burnham: I will not give way.
	We have seen in all its painful unravelling that Tory health policy is confused, contradictory and dangerous.

Michael Penning: Feeble!

Andy Burnham: The hon. Gentleman should listen, because we have a policy to tackle MRSA. It begins with a clear national target that, today, the shadow Secretary of State said that he would scrap. We have put £50 million into the NHS in the past few months to enable hospital trusts—including his trust, about which an announcement will be made next week—to make improvements.

Michael Penning: Will the Minister give way?

Andy Burnham: No, I will not give way.
	The Government have introduced a legal code that places statutory responsibilities on NHS trusts to tackle hospital-acquired infection. That is our policy. We know that we have got a good package. What is Conservative party's policy? We have heard today that it is to scrap the target, install a few washing machines and hope for the best. I am afraid that that is simply not good enough. All the momentum that we have established in tackling MRSA would be lost in the Tory NHS, and Lansley's La-la land, where Ministers have no role and everything happens by magic. What a wonderful place it must be.  [ Interruption. ]

Madam Deputy Speaker: Order.

Andy Burnham: I shall deal with the points that have been raised in today's debate. The hon. Member for North Norfolk (Norman Lamb) made an excellent contribution. I did not agree with every word that he said, but he made some very valid points. He asked about the advice to Ministers in the memo. I think that he said that it used the phrase "MRSA would never be beaten." The memo does not say that; it says that achieving the target will be challenging and that some in the Department question whether it can be achieved.
	Let me, in all honesty, give the hon. Gentleman my best answer, and this is what I believe. Yes, it is a challenging target. It was challenging to the NHS when it was set, but that was the point of the target. Its purpose is to cut infection, not to generate comfortable or pleasing headlines for the Government. I would rather we had a real go at meeting that target and changing the culture right across our national health service, even it we miss it by 5, 10 or 15 per cent., because we would thereby deliver a major reduction in infection in the national health service and we would improve patient safety. I reject the approach that the hon. Gentleman advocated of scrapping the target entirely.

Norman Lamb: The Minister insists that he is going to stick with the MRSA target, but what about C. difficile? Although MRSA levels have come down, C. difficile levels are increasing at a disturbing rate.

Andy Burnham: The hon. Gentleman raises a fair and important point. People have spoken about the memo and Liz Woodeson, and now that the memo is in the public domain, it is right to comment on it. As a result of that memo, we did two things in the Department. We made £50 million available this financial year to the national health service. That equates to £300,000 per trust. The trusts can use that money to make practical improvements to their estate, such as more isolation facilities or washroom facilities—if that is what they choose. It is up to the NHS trust concerned to put those measures in place. That is specifically linked to C. difficile and the challenge that we face in relation to that. At the same time, we have asked every PCT, as part of the model contract, to negotiate with its main providers a target for cutting C. difficile. We believe that that is the right approach: to keep our headline national target on MRSA, but to put in place action to cut C. difficile.

Adam Afriyie: Will the Minister give way?

Andy Burnham: No, I would like to make some progress. The people who took part in the debate raised many points and I would like to answer them.
	The hon. Member for North Norfolk rightly raised the question of antibiotics. The guidance that the chief medical officer and chief nursing officer have issued to the national health service makes the same point that he made about a safe prescribing policy for broad-spectrum antibiotics. The code of practice that I have already referred to requires there to be an antibiotic prescribing policy in place. I could go through more measures, but I wanted to give him an answer. There is action in hand to tackle the important point that he raised.
	My hon. Friend the Member for Crawley (Laura Moffatt) made an outstanding speech. She spoke with real authority, unlike the bar-room brawlers on the Opposition Benches. She cut through the fug of the debate with real precision and made some superb points about the effect of mandatory surveillance in changing how we view these things. She also made another important point. She worked in the national health service— [ Interruption. ] Opposition Members do not like to hear this. She worked in the national health service between 1992 and 1997 and she made it clear that, at that time, there was no drive whatsoever to address this issue, which was developing and taking root in the NHS underneath the noses of Conservative Ministers. She made that point powerfully.
	I understand the reasons why the right hon. Member for Maidstone and The Weald (Miss Widdecombe) cannot be here for the closing speeches and we wish her well. She described some unacceptable conditions—if they are true—in her trust. Nobody would condone them. If people in the trust need to read those comments, I hope that they will. However, she did something that characterised the approach to the debate by Opposition Members all afternoon. It veered dangerously close to a direct attack on NHS staff. A small number of cases and anecdotal evidence were used to damn the practice of many of our fantastic and hard-working— [ Interruption. ]

Madam Deputy Speaker: Order. The Minister is responding to points. If Members wish to comment, they can seek to intervene in the usual way.

Andy Burnham: It is important to say that the trajectory for cases of MRSA at that trust is 49. The actual figure is 47. The rate of improvement is better than the target. Yes, there are issues about C. difficile at the trust, but we have asked the Healthcare Commission to look at them, as has the strategic health authority. I am sure that the commission will come back with its findings shortly.
	Many hon. Members raised the issue of staff uniforms. It is important to say that there is no real evidence that uniforms or work-wear are a major source of cross-infection. However, I accept the point made by Opposition Members that it might be an issue of public confidence and a question whether people believe that there is an adequate hygiene policy in place. In the light of that concern, a review of current uniform policy has been taking place. Its conclusions will be available shortly.
	Concerns were raised about the £50 million fund. The hon. Member for Hemel Hempstead (Mike Penning) raised that issue in relation to his trust. Announcements will be made in due course.

Michael Penning: rose—

Andy Burnham: I have not got much time left, so, if the hon. Gentleman does not mind, I will pick up the points that he raised. He raised a point about contract cleaning, as did other Members. It is vital that the cleaning team in any trust is fully integrated into that trust, and that its views are listened to and it is consulted when action is taking place. We do not want a situation in which contract cleaners do not feel that they are a full and involved part of the trust in question.
	I asked the hon. Member for Leominster (Bill Wiggin) —[ Interruption. ] I am sorry if I mispronounced his constituency. I asked him to say what the percentage increase in MRSA was between 1990 and 1997. He did not have an answer. Let me give it to him: between 1990 and 1997, MRSA increased by 3,332.4 per cent. in our national health service. I did not hear any recognition of that, nor did I hear what action was taken. If this debate succeeds in nothing else, it should inform the House of a stark fact: the Conservative party is committed to scrapping the one thing that has turned the tide in the fight against MRSA on our wards. MRSA levels rose inexorably in every single year between 1990 and 2004. That was the year that the MRSA target was introduced. Since then, infection levels have fallen every year. I am not complacent, but let us get those facts on the record. If the Conservative party is committed to cutting that target, Conservative Members have some explaining to do. Do they think that the reduction in recent years was in any way connected to the introduction of that target? Do they think that it is just possible that its existence has brought some ownership and focus from the top of NHS organisations? Can they produce evidence that the target can be safely scrapped and that that would not lead to infection levels creeping up again? If they cannot, they should have a rapid policy review and change their minds quickly.
	Today's motion calls for a "search and destroy" policy and that was mentioned earlier. I know that the Conservatives have embarked on a systematic campaign to disown and forget every policy that they once had, but there was a search and destroy policy in the national health service in the 1980s. It got dropped when cases began to emerge and the NHS was overwhelmed. It could not cope, because the Conservatives cut capital spending year on year between 1992 and 1997 and they cut revenue spending. The Conservative party's claims of a crisis have an increasingly hollow ring. There has been a real and sustained improvement in relation to all the fundamental issues that show that our NHS is improving, but we are not complacent. We will continue to challenge the NHS to do more.
	The Conservative party poses as the friend of NHS staff, but we Labour Members remember the posters saying
	"I mean, how hard is it to keep a hospital clean?"
	It was a sneering Tory two fingers to every single hospital cleaner in the country, and it was sanctioned by— [Interruption.]

Madam Deputy Speaker: Order.

Andy Burnham: The Tories say that they have changed, and that they support our national health service, yet they pick away at the issue and undermine our NHS staff because that has the potential to damage confidence in our NHS. We do not claim to get everything right, but we are no fickle friends of the NHS. We will stand by our national health service and give it the resources to do the job.

Question put, That the original words stand part of the Question:—
	 The House divided: Ayes 222, Noes 289.

Question accordingly negatived.
	 Question, That the proposed words be there added,  put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Madam Deputy Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House welcomes the top priority given to reducing healthcare-acquired infections by this Government; recognises that the Government is the first ever to collect data on these infections including establishing the world's most comprehensive MRSA surveillance system; further welcomes the new code of practice for health and social care providers introduced under the Health Act 2006 to reduce infections like MRSA and the new duty on the Healthcare Commission to ensure service providers comply with the code; welcomes the Government setting a target to halve rates of MRSA by 2008; notes the progress towards achieving this target; acknowledges that more must be done to achieve this goal; and therefore welcomes the priority given to reducing healthcare-acquired infections in the operating framework of the NHS in 2007 and the additional £50 million given to NHS trusts in December 2006 to tackle healthcare associated infections.

Disabled Children

Madam Deputy Speaker: We now come to the second Opposition debate on the life chances of disabled children.  [ Interruption. ] Members not wishing to participate should leave the Chamber as quickly and quietly as possible. I remind the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.

Jeremy Hunt: I beg to move,
	That this House notes the plight of the UK's 570,000 disabled children and the 55 per cent. of their families who are living in, or on the margins of, poverty; further notes with concern the Children's Commissioner for England's view that services for disabled children are a 'national scandal'; acknowledges the link between disability and child poverty; believes that the Government's target of halving child poverty by 2010 and eradicating it by 2020 will not be achieved without a strategy that seeks to improve the life chances of disabled children; welcomes the interest in short breaks for families with disabled children shown by the hon. Members for Normanton and Devon South West in their previous and proposed private members' bills and looks forward to the Government's response; believes that the current system of assessment and support provided for families with disabled children is complicated, bureaucratic, costly and stressful for both disabled children and their parents; further believes that the complexity of the benefit system acts as a barrier to employment for parents of disabled children in a way that prevents social mobility and entrenches poverty; and therefore calls on the Government to build on legislative progress on disability issues made under this and previous governments by simplifying the assessment processes and reducing the complexity of the benefit system for families with disabled children in order to prevent disabled children and their families being trapped in poverty.
	It has been said that
	"services for disabled children and their families are a national scandal".
	Those are not my words, but the words of the Children's Commissioner for England. That is shocking, as there has not been a lack of good intentions on the Government's part, or a lack of legislation, or a lack of willingness to invest in services, as evidenced by the Carers and Disabled Children Act 2000, the Special Educational Needs and Disability Act 2001, the 2003 Green Paper entitled, "Every Child Matters", the Children Act 2004, the life chances report of 2005, the Disability Discrimination Act 2005 and, last year, the Treasury policy review of children and young people, which reported its interim findings this month. I could go on, and it is hard to disagree with anything that the Government say in those reports. However, there has been a failure to deliver meaningful change to the lives of hundreds of thousands of families with disabled children.
	A recent parliamentary inquiry chaired by the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) and the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) found that 81 per cent. of parents with disabled children rate social service delivery as poor, and that 52 per cent. rate the delivery of educational services as poor. When it comes to disabled children, it is clear that not every child matters.

Joan Humble: As the hon. Gentleman refers to the report and the parliamentary hearings, will he acknowledge that the report identifies some examples of good practice, such as the early support programme, and that part of our report advised the Government that they should extend the elements of good practice, so the picture is not totally bleak?

Jeremy Hunt: I agree that there were some positive aspects—not everything is negative—but the overwhelming majority of parents with disabled children express extreme frustration. The hon. Lady's report was extremely valuable because it highlighted the progress that still has to be made.

Tom Clarke: Will the hon. Gentleman give way?

Jeremy Hunt: I am delighted to give way to the right hon. Gentleman, who co-chaired the inquiry.

Tom Clarke: I am grateful. As the hon. Gentleman was kind enough to refer to me, and as I am asked to support the motion that he and his colleagues put before the House, may I ask what is the source of the figure in the first line of the motion, which refers to
	"the UK's 570,000 disabled children"?

Jeremy Hunt: The source of that figure, I am happy to tell the right hon. Gentleman, is the interim findings of the Treasury's policy review on children and young people, which quotes that as the number of children who qualify under the Disability Discrimination Act 1995, but the life chances report refers to 272,000 disabled children, so there is obviously some doubt as to the precise number. On average, it is clear that one in 20 children has a significant disability.

Tom Clarke: So that we are in a position to discuss the facts as the evening goes on, may I gently put it to the hon. Gentleman that the motion has got it wrong? The figure accepted by the Treasury and the Department for Education and Skills is, for the United Kingdom, 770,000. Does he not realise that the figure that he has given is for England alone?

Jeremy Hunt: The right hon. Gentleman may be correct. That might explain the discrepancy between the two figures, but whether it is 570,000 or 772,000 is not the substantive point behind the motion.
	The hon. Member for Blackpool, North and Fleetwood, who co-chaired the report, spoke about the progress made in the early support programmes introduced by the Government. The assessment by the university of Central Lancashire examined those programmes and concluded that one of the key issues of concern to parents participating in the programmes was the transparency of the decision-making process. I hope to return to that later in the debate.

Bob Spink: Does my hon. Friend agree that one of the areas in which the Government are failing our children is in the provision of speech therapy? Does he also agree that we need clarity on the importance of the provision of speech therapy, on the shortages that exist, and on when the Government intend to remove those shortages?

Jeremy Hunt: My hon. Friend makes an excellent point. I know that he has spoken on the matter in the House on many occasions. I commend the work of many of the campaigning organisations, such as I CAN, which have done a great deal of work on speech and language therapy. Of particular concern is the finding that 50 per cent. of five-year-olds are at risk of falling behind and possibly moving into social exclusion if the challenges that communication presents for them are not addressed immediately. That figure rises to 80 per cent. of children in socially deprived areas.
	In the debate, I shall examine not only the problems faced by parents and carers of disabled children, but why, unless we tackle the link between disability and poverty, the Government will fail to make progress towards their child poverty targets. Let us start, though, by looking at the challenges faced by a parent who has a disabled child. I was talking to some mothers of disabled children in Essex and in London last week. They spoke about the mind-boggling complexity of the benefits system, which requires them to fill out eight different forms—for the carer's allowance, the carer's premium in income support, child tax credits, child benefit, the community care grant from the social fund, disability living allowance, disabled facilities grant and housing benefit.
	I have all the forms. I know that this is a subject in which you take a great interest, Madam Deputy Speaker, and on which you might have wanted to contribute had you not been Deputy Speaker. Can you guess how many questions we ask a parent in that situation to answer? The answer is 1,118 questions spread over 273 pages. Let us be clear—those parents are probably in the most vulnerable situation in their lives, which could lead to the break-up of their marriages, if they are married. They almost certainly see a significant drop in their disposable income. What do we do? We make them take an exam.
	One cannot accuse the people who write the forms of not having a sense of humour. Part 22 of the disability living allowance form for adults, in the section headed "Communicating with other people", asks:
	"Do you have problems ... filling out forms?"
	The form continues:
	"Describe in your own words the problems you have and the help you need".
	Many of the questions on the forms are not designed for simple yes or no answers—they require a paragraph of prose describing one's situation. That is much more difficult for socially disadvantaged parents than for articulate, middle-class parents who are capable of fighting for their rights.

Angela Watkinson: I am grateful to my hon. Friend for allowing me to intervene. He is speaking about questions. Is he aware that there is a very important question—one single question—that a group of parents from Ravensbourne school in my constituency, who have children on the autistic spectrum, regularly put to me? They say, "Please, please, may we have some respite care?" For those children, respite care must be specific to their needs. The daily lives of those families are extremely difficult and, they say, if only they could look forward, perhaps once or twice a year, to just two days when the child was in respite care, it would make all the difference, but it is not available.

Jeremy Hunt: My hon. Friend makes an important point. I know that she knows a great deal about the matter. I shall deal with the lack of respite care later in my remarks.
	With reference to the forms, it is worth pointing out the number of complaints made by parents of autistic children about the inadequacy of the DLA, and in particular its inadequacy in identifying non-visible disabilities. There is no question on the DLA form that asks, for example, how many times the child ran away last month, but that is the kind of challenge with which parents of autistic children have to deal. It is clear, and I am grateful to my hon. Friend for highlighting it, that we need much greater awareness of conditions such as autism in the working of the benefits system.
	It might be suggested that the reason why we ask parents 1,118 questions is that disabilities are complicated and we need to understand the facts, but 23 questions are repeated on every form, three quarters of the questions on the forms are repeated at least twice, a third of the questions are repeated at least three times, and a quarter—that is 274 questions—are repeated at least four times. Perhaps that is because they apply to different Government Departments. Let us quietly forget the Prime Minister's comments to the civil service conference in 1998 about
	"joined up policy making for joined up services".
	However, six of the eight forms are from the same Department—the Department for Work and Pensions.
	The result of the complexity is very low take-up of benefits. The Child Poverty Action Group estimates that about half of parents of disabled children claim DLA. The survey by the Child Poverty Action Group and Contact a Family showed that a third of parents are put off claiming DLA by the complexity of the form.

Angela Browning: One of the difficulties with benefits such as DLA, which does not consider diagnosis but examines the way in which the disability affects the child, is that if one goes to appeal, the people who sit on tribunals do not have the specialist knowledge to translate the questions to ascertain how the child's life is affected. It is important to take into account not only the diagnosis or the disability, but the effect on the child's life when ascertaining whether the child qualifies for DLA. It is time we had more specialists on tribunals and appeals panels so that a fair hearing can be given.

Jeremy Hunt: My hon. Friend has campaigned a great deal in the House on autism. She makes an important point. Her point about appeals amply demonstrates the lack of confidence that the parents of autistic children have in the benefits system. That is also shown by the fact that 13 per cent. of parents take five or more years to apply for DLA.

John Barrett: Would it not make sense for all the information to be made available at an early stage to parents who have disabled children? One reason for the points that the hon. Gentleman makes is that many parents are unaware of the benefits to which they or their children may be entitled. By missing out on an early claim, they may not only lose substantial sums of money, but may find that the assessment is made on a different basis, and thus lose out on a significant sum for many years after that assessment.

Jeremy Hunt: The hon. Gentleman makes an important point. Almost a third of parents in the Child Poverty Action Group survey said that they did not know where to go for independent benefits advice.
	Not only the benefits system but the social care system causes problems. Mencap describes a system whereby more than a third of parents have to juggle eight or more different professionals for social care packages. One parent who spoke to the parliamentary inquiry said that she had to deal with 21 different professionals, and that the co-ordination so exhausted her and her family that she came close to family breakdown as well as being unable to consider work.
	There are different systems. In Austria, there are single, multi-disciplinary assessment teams, which consist of a child doctor, a paediatric nurse, a physiotherapist and an information officer, who come together as soon as a disabled child is born. That team is at parents' disposal, not only for the initial assessment but afterwards, when they need support. During my first Question Time as a Front Bencher, I asked the Under-Secretary of State for Work and Pensions, the hon. Member for Stirling (Mrs. McGuire), whether she would consider an Austrian-style system in this country. She replied:
	"The Austrian experience is particular to the Austrian environment, and I am always reluctant to assume that one can necessarily import a system from another country".—[ Official Report, 13 March 2006; Vol.443, c. 1144.]
	We cannot import another country's system lock, stock and barrel, but could we not at least learn from the way in which other countries do things? If we are not even prepared to learn, there is a danger that some people will interpret well-intentioned failure to make progress as woeful complacency.
	When we talk to constituents, groups that campaign for parents with disabled children and carers who look after disabled children, they mention the education system time and again. Last week, I spoke to a lady who told me that it took 11 steps for her to get the right education package for her child, who is four years old and has severe cerebral palsy. The local education authority assigned her a school that she did not like. She contacted the LEA and was told that a child psychologist would have to assess the child at nursery and in the home. She was given 10 days to find alternative schools but she was not given a list of accessible schools. She was then offered a choice of two schools, neither of which was on her preferred list. One was a drive of an hour and 10 minutes, which would mean a round trip of two hours and twenty minutes.

John Hayes: My hon. Friend made an impressive speech at the all-party group on disability last week. He talks about a system that at least bamboozles and at worst intimidates many concerned parents of vulnerable youngsters. The real cost is that those youngsters' needs are not identified early enough. That is critical for conditions such as autism and many others. We are not giving those children what they need at the stage that they need it.

Jeremy Hunt: My hon. Friend, who plays an active role in co-chairing the all-party group, makes an important point. A single, multi-disciplinary assessment team would be one way of ensuring effective early intervention.
	Let me revert to the example of the 11 steps—I shall not go through them all. In the end, the parent was able to get her child into the local infants school where she wanted him to go all along. However, she was told that he could go only part-time because it would take six months to install disabled toilets. Six months have passed and she has been told that it will take another two years. The child has to go to the toilet in the stationery cupboard. The mother is articulate and knows how to fight for her rights. One of the educational professionals who spoke to the parliamentary inquiry pointed out that the system is
	"inherently discriminatory against the most socially disadvantaged".

Philip Davies: My hon. Friend is not only making an excellent speech, but has done a fantastic job in highlighting disability issues over many months. He mentioned accessible toilets for people with disabilities. Let me highlight the Changing Places campaign, which has been organised by Mencap, among others. Does he agree that one of the main problems that the parents of disabled children face is taking the children to the toilet at school or outside school, for example, in supermarkets? Will he join me in encouraging as many organisations as possible to provide the sort of facilities that the Changing Places campaign mentions, so that they are fit for purpose?

Jeremy Hunt: My hon. Friend has a long-standing interest in disability issues, which dates from the time he worked at ASDA. He makes an important point. The problem especially affects disabled children who are not toilet trained, are aged 10 or 12 and still need to use nappies. If they cannot access the proper sort of toilets, they have to lie on the floor of a public toilet so that their mother can change the nappy. One way of tackling that is providing properly accessible toilets and the other is to make trainer nappies, which allow nappies to be changed while a child is standing up, more widely available.
	The perceived independence of the assessment system in education is critical. Many parents feel that a system whereby the assessing authority is also the funding authority will not make a fair assessment. That is why Sir Robert Balchin's special educational needs commission, which my right hon. Friend the Member for Witney (Mr. Cameron) set up when he was shadow Secretary of State for Education and Skills, recommended breaking the link between assessment and funding.
	The Government have not shown much willingness to grasp the nettle. The Select Committee on Education and Skills reported
	"significant failings in the system that need to be dealt with urgently."
	The Government's response to the report was that
	"the evidence does not, in the Government's view, suggest a system in need of fundamental review".
	According to parliamentary answers that I received, no Minister from the Department for Education and Skills has attended the Office for Disability Issues meetings.

Anne McGuire: That is not true.

Jeremy Hunt: I am happy to give way to the Minister, but I have a copy of the answer to the parliamentary question.

Anne McGuire: I intended to deal with the matter in my speech, but I suggest that the hon. Gentleman looks at the parliamentary question and identifies the Minister about whom he posed the question. He asked for the attendance of a Minister who is not a member of the cross-ministerial group.

Jeremy Hunt: I am interested to hear that response from the Minister. Perhaps she would like to know why I asked that particular Under-Secretary of State at the Department for Education and Skills how many times he had attended meetings of the Office for Disability Issues. It was because of a response that the Minister herself had given me in answer to a parliamentary question about which Ministers were members of the ministerial oversight group.

Anne McGuire: As the hon. Gentleman supports a bicameral system in Parliament, he may be aware that there is more than one Under-Secretary of State in the Department for Education and Skills; the other one is a Member of the other place.

Jeremy Hunt: We asked the Under-Secretary of State in this place, and we got a reply from the Under-Secretary of State in the other place. So we have been in touch with both of them, and there does seem to be some confusion over the issue.
	A further group of people who are severely short-changed by the way in which we look after families with disabled children are the taxpayers. As taxpayers, we want to help families in that incredibly vulnerable situation, yet we see that of the £5.4 billion that is spent supporting such families through the social care budget, £1.1 billion— 26 per cent.—is used up by the assessment and commissioning process. That money does not go towards providing the services that the families need. We have also discovered that, according to parliamentary answers on the administration of the disability living allowance, £630 million was lost through official error. About £360 million was lost through official error relating to housing benefit, £110 million through official error relating to income support, and £10 million through official error relating to the carer's allowance.
	One third of the families who have access to short breaks say that their access has been cut over the past year, and eight out of 10 families say that they are at breaking point due to the lack of access to short breaks.

Gary Streeter: Will my hon. Friend give way?

Jeremy Hunt: I will be happy to give way to my hon. Friend. I want warmly to commend him for his private Member's Bill and to bring it to the attention of the House.

Gary Streeter: Before my hon. Friend warmly commends me, may I ask him whether he agrees that one of the most poignant moments for all of us in our surgeries is when parents of severely disabled children explain their story to us? They always look exhausted, and they hate to complain, but the one thing that they always ask for is access to respite care or to a short break. Is it not worrying that, for a variety of reasons that we all understand—pressure of budgets and so on—respite care is being cut back in many parts of the country? In addition to warmly commending me, will my hon. Friend encourage the whole House to be here on 23 February to support the Disabled Children (Family Support) Bill? That Bill will place a duty on local authorities and health authorities to make adequate short break provision available. Is not that the right way forward?

Jeremy Hunt: I warmly commend my hon. Friend for bringing that issue to the attention of the House. Why cannot the Government look into the possibility of reforming and streamlining the assessment and commissioning process, so that funds could be found to finance the important respite care that my hon. Friend has described?
	I mentioned earlier that a major consequence of our failure properly to support families with disabled children is a lack of progress on the child poverty targets. We know that more than half the families with disabled children live either below the poverty line or on the margins of poverty. We also know that disabled children are twice as likely as other children to be receiving free school meals. The Government's strategy on child poverty has essentially been based on income transfer and on ensuring that vulnerable families have enough money in their pockets to buy what they need to live on. I want to adapt a well-worn phrase to suggest to the Government that, as well as being tough on poverty, we need to be tough on the causes of poverty. That means looking not only at income transfer, but at removing the barriers to social mobility. The complexity and bureaucracy of the system prevent social mobility at the moment.
	I spoke to the mother of a disabled child recently, and she told me that she earned £2 a week more than she was allowed to on the carer's allowance—the limit is £84 a week—and that she was now being asked to repay £1,600, which of course she does not have. I remember the parent who spoke to the parliamentary inquiry and described how having to juggle 21 professionals made it impossible for her to think about work. I put it to the House that the role of social mobility in combating poverty is one of the main areas of difference between ourselves and the Government. We all support the aspirations of the child poverty targets, and I urge the Government to look at the role of social mobility as they review their child poverty strategy.
	The policies that we adopt on families with disabled children must be central to social policy because it is about the family. A healthy society has healthy families—social breakdown occurs when we have family breakdown. There is much that is wrong with our support for families with disabled children, but perhaps the thing that is most wrong is the poverty of ambition in regard to what can be achieved. Some people say that there are no heroes any more, but every hon. Member knows that the true heroes and heroines of our time are the parents and carers of disabled children. They want nothing more than to focus all their energy, attention and efforts on bringing up their much-loved children. Instead, we make them battle against the system. Let us scale up our ambition and give them a system worthy of their great efforts.

Anne McGuire: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the fact that this Government acknowledged the challenges faced by disabled children and their families by publishing a report in 2005, Improving the Life Chances of Disabled People; welcomes the establishment of an Office for Disability Issues to improve coordination of disability policy across Whitehall and provide a forum for the voice of disabled people; recognises that the Government committed itself to improve outcomes for all children and young people through its change programme—Every Child Matters—which is driving change in local areas through the establishment of Children's Trusts; commends the Government in its specific focus on disabled children in the disabled children's standard of the Children's National Service Framework and the Special Educational Needs strategy, Removing Barriers to Achievement; acknowledges the Government's close working with stakeholders from the disabled children sector in developing its work programme; notes the Government's investment in support services for families with disabled children through its funding of the Family Fund and the Contact a Family national help line; commends the success of the Government's Early Support Programme for young disabled children; further commends the introduction of direct payments for families with disabled children and disabled young people, which increase choice and control and empowers those families; and congratulates the Government's commitment to further improving services for disabled children through the disability strand of the Children and Young People Policy Review.".
	I thank the hon. Member for South-West Surrey (Mr. Hunt) for his opening comments. We have had an opportunity to get to know each other over the past year or so, especially during the progress of the Welfare Reform Bill, and I certainly do not doubt his integrity or his commitment to the cause that he espouses. Having said that, I want to say that, contrary to the words in the Opposition's motion, the Government do have a record to be proud of in extending the rights and opportunities of disabled people and in supporting disabled children.
	Having paid the hon. Gentleman a compliment, I must observe that there are other members of the Opposition who have come very late to the disability debate. However, I very much welcome their interest and their contribution to the debate, both on the specific agendas around disabled children and on the wider issues.

Bob Spink: Will the hon. Lady give way?

Anne McGuire: Not at the moment. I have not yet said very much for the hon. Gentleman to comment on, so I hope that he can hold it for a second. I hope that it will give him some comfort if I say that there have always been hon. Members on the other side who have championed disability rights, and I shall go on to talk about some of the difficult times had by the Conservatives in trying to champion those issues.
	This debate is timely because of the emerging findings of the children and young people review carried out by Her Majesty's Treasury and the Department for Education and Skills, which was published on 9 January. As the hon. Member for South-West Surrey said, the review considers specifically what action needs to be taken to improve outcomes and equality of opportunity for disabled children and their families, and it will feed directly into this year's comprehensive spending review.
	I would like briefly to remind the House of the commitments made in the Prime Minister's strategy unit report, "Improving the Life Chances of Disabled People", which the hon. Member for South-West Surrey mentioned. I shall also talk about some of the progress being made in respect of disabled children. Finally, I shall reflect on some of the challenges ahead.
	Before I begin, however, I must take the Opposition to task for their attempt to airbrush out of history some of the actions and—dare I say it?—inaction that characterised their approach when they were in government and in a position to do something about some of the issues that have been highlighted today. At best they did not improve the lives of disabled children, and at worst they exacerbated some of the problems— [ Interruption.] The issues raised here this evening did not miraculously appear on the scene in 1997.
	My right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), who will hope to catch your eye later in the debate, Madam Deputy Speaker, will remind the House of some of the difficulties in trying to take on the disability agenda.
	When the Opposition were in power they had a golden opportunity, over 18 years, to make a real difference to the lives of disabled children. They did not take it.

Jeremy Hunt: I know that it is one of the coldest days of the year but I was not expecting such a frosty account from the Minister. In the interests of a balanced picture, will she congratulate the Conservative Government on the introduction of the disability living allowance in 1992, the introduction of the first Disability Discrimination Act, in 1995, by my right hon. Friend the Member for Richmond, Yorks (Mr. Hague), which was described by the  Equal Opportunities Review as the most significant piece of discrimination legislation in a generation, the Carers (Recognition and Services) Act 1995, and the introduction of direct payments in 1996?

Anne McGuire: I will refer to some of the issues that the hon. Gentleman highlights. He did not mention that a Conservative Government introduced the Education Act 1981, which defined special educational needs and set out the process for identification and multidisciplinary assessments, including statements. They forgot, however, to make that right enforceable: there were no time limits for assessments or statements, and no clarity about the role of local authorities. It took 13 long years to get those rights established for the very parents about whom he talks, albeit under a Conservative Government, in 1993. When his party was in a position to make a difference to the lives of disabled people in this country, it either acted reluctantly or not at all.

Jeremy Hunt: Will the Minister give way?

Anne McGuire: No.
	Credit ought to be given to the right hon. Member for Richmond, Yorks (Mr. Hague) and the previous Prime Minister, the former Member for Huntingdon, for the Disability Discrimination Act 1995, because they had to force that Act through in the teeth of opposition from many Conservative Back Benchers. My right hon. Friend the Member for Coatbridge, Chryston and Bellshill, who was in the vanguard of some of those campaigns, will remember that.

Tom Clarke: I must disappoint my hon. Friend: I had not planned to speak. However, may I lend some support to her advice to the Opposition? If they really want to change policies and make progress, which may be the case, they would be extremely wise not to refer too often to their record in government, not least because, even in the Disability Discrimination Act, the right hon. Member for Richmond, Yorks (Mr. Hague) steadfastly resisted the introduction of the Disability Rights Commission. I remembered that when I saw in the new year's honours list that its chair, Sir Bert Massey, had received a well-deserved knighthood—although I am not sure that that would have been widely shared.

Anne McGuire: My right hon. Friend has highlighted the very point that I was going to make: the Disability Rights Commission was established by this Government to give teeth to the DDA, because the previous Conservative Government forgot to think about how that Act would be enforced. The previous Conservative Government could have made a significant difference. However, the child poverty statistics show that they oversaw the greatest ever increase in child poverty in this country, when one in five families had no one in work, and one in every three families were living in poverty. That is a terrible legacy, which the Government are committed to overturning, and I welcome the support of the hon. Member for South-West Surrey for that.
	In welcoming the conversion of Conservative Members to the cause—with the honourable exception of those Conservative Members who were always part of the campaign, to whom I give credit—may I confess to the House that I have sometimes taken a rather jaundiced view of their contribution to the debate in past years?

Adam Afriyie: Will the hon. Lady give way?

Anne McGuire: Not just now.
	I believe that political parties should be judged on what they do in government, not by the rhetoric that they use in opposition.

Bob Spink: If the Minister believes that political parties should be judged on what they do, will she readdress, in a spirit of working together, the policy that has seen 100 special schools close under the Labour Government?

Anne McGuire: As the hon. Gentleman knows, that issue causes grave concern across the country. It is also an issue for local authorities. Conservative local authorities are making some of the difficult decisions about special needs education. If I have time, I shall refer to special needs education in a few moments.
	The Government have made real progress in putting the life chances of disabled people, and especially of disabled children, at the heart of our policy: extending educational opportunities; improving the benefit system and raising levels of benefit; opening up opportunities for disabled people to move into work; transforming the civil rights of disabled people; ensuring that public authorities put equality for disabled people at the core of their activities; and tackling poverty.

William McCrea: Last week, the BBC alerted my constituents to the fact that more than 100 young people with profound learning disabilities have been kept in Muckamore Abbey hospital, and have not been able to get out into the community, because there is no care in the community available or place for them to go. It also found that 20 young people are in locked-up wards in that hospital, when there should not be locked-up accommodation at all. Surely something ought to be done about that.

Anne McGuire: I do not have any difficulty in agreeing with the hon. Gentleman's comments.
	I shall shortly refer in turn to the issues that I have identified. Let me also state, so that there can be no doubt, that we are not at all complacent about what must be done, and nor are we afraid to listen to the concerns of disabled people. That is why the Prime Minister's strategy unit conducted the first comprehensive study of the life chances of disabled people, leading to the first ever cohesive cross-government strategy to deliver equality for disabled people. That is also why the Government asked my right hon. Friend the Member for Coatbridge, Chryston and Bellshill to establish the recent Parliamentary Hearings on Services for Disabled Children, which were cross-party, open and transparent—and, yes, critical—so that Parliament could hear at first hand about the pressures and difficulties that parents, carers and children face on a daily basis. I think that my right hon. Friend will agree that that is probably the first time that a Government have specifically charged a group of parliamentarians to undertake such an exercise. The report of the evidence gained was delivered officially to the Government by him and his committee, and it will inform the discussions that are currently taking place as part of the comprehensive spending review.
	Yes, there were some tough messages in the report, and we will not run away from them. But there were also some positive comments. The early support system was highlighted as having produced a dramatic change in the lives of families with disabled children. According to the report, evidence given at the parliamentary hearings made it clear that the early support programme is one of the Government's great success stories in relation to disabled children. It was not all gloom and doom.
	Let me turn briefly to how the strategy has been undertaken and what progress we have made. The life chances report marked a real step change in the way that Government think about the impact of their policies and services on the lives of disabled people. Why is that? Because for the first time ever, a Government took as their starting point the belief that people are disabled not by their impairments but by the way in which society responds to them—or, in many cases, fails to respond to their needs and aspirations. The report set a clear and ambitious vision for Government: that by 2025 disabled people should have the same opportunities and choices as everyone else, should be respected as equal members of society, and should be able to participate as equals in every aspect of family and community life.
	We can bandy various figures, but according to the life chances analysis, 700,000 disabled children and young people in Britain face a number of specific barriers, some of which have been identified this evening, which make it more difficult for them to achieve their full potential. Their families often experience high levels of stress, they are more likely to live in poverty, and they are more likely to face an increased risk of social exclusion. Their future life chances are critically affected by the support and services that they receive. This was a Government report, this was a Government strategy unit, and this was a Government who were prepared to face up to difficult issues.

Angela Watkinson: May I commend to the Minister the ROSE—real opportunities for supported employment— project at Havering college of further and higher education, which helps students with learning difficulties into work? It is highly successful, and an example of good practice that could be copied throughout the country. The main difficulty is not finding employers who are sympathetic and willing to take on such students, nor is it persuading the students to take on jobs, because they are keen to do so. The main difficulty is that parents are worried about losing benefits if their children work for more than 16 hours a week. That is a problem that we could easily overcome.

Anne McGuire: As I am sure the hon. Lady will appreciate, there is always a balance to be struck. Deciding where the dividing line should be for the disregard of income for people on benefits is always tricky. Interestingly, more often than not people come to me with the opposite problem: rather than wanting to work for more than 16 hours, they want to work for less than 16 hours. I believe that the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander) raised that point during the Committee stage of the Welfare Reform Bill. In any event, it is a delicate balance: too much and we call the benefits system into question, too little and it may act as a disincentive for young people to try work. We are constantly trying to find ways of finessing the system.

Joan Humble: Part of the question asked by the hon. Member for Upminster (Angela Watkinson) concerned a difference of opinion between parent and child. Such disputes do occur. Does the Minister agree that we need good-quality advocacy services so that the voice of the child can be heard? Sometimes young people want something other than what their parents want, which is often because parents are, understandably, being over-protective.

Anne McGuire: I think that that is why some of the issues are difficult to discuss in a forum such as this. Children or young people may want to express their ambitions in a way that conflicts with their parents' understandable worries about whether they are capable of living independently. I know of many parents who are deeply concerned when a learning-disabled child says, "I want to move into a flat of my own." Mum and Dad may not think that that is achievable, but if the right support systems are there it can be done in a way that will not cause the young person any difficulties.
	When I was having meetings on the United Nations convention on the rights of disabled people, I was impressed by two young people aged 18 and 19 who told me of their deep concern about the fact that for many years other people had spoken for them. They wanted to speak for themselves, and they had a powerful message to convey. They were fed up with doctors, nurses and parents speaking for them; like all teenagers, they did not want their parents to speak for them. There are complex issues, and I am grateful to my hon. Friend for pointing that out.

Angela Browning: There tends to be a gap between children's and adults' services. Does the Minister agree that one way of making the transition successful is to provide multidisciplinary teams, and to ensure that the transition is seamless? All too often, once the statutory responsibilities end when a young person is 16 or 18 there is a long wait before anything else happens, and that causes a great deal of distress.

Anne McGuire: I greatly respect the hon. Lady's knowledge and expertise. She has drawn attention to an important issue, which was mentioned in the strategy unit report. A cliff edge is reached when young people reach 16, 17 or 18, and they may be covered neither by children's services nor by adults' services.

Andrew Rosindell: rose—

Anne McGuire: Others may wish to speak, but I will take the hon. Gentleman's intervention because—well, I will take the hon. Gentleman's intervention.

Andrew Rosindell: I thank the Minister. Does she agree that an holistic approach is needed to give more opportunities to young people with disabilities, including learning disabilities, and also to ensure their safety? There is a learning skills centre for disabled young people in Western road in my constituency, but because of bureaucracy on the part of the council and Transport for London, the centre is not being allowed a pedestrian crossing to make those young people's lives more safe and secure. Will the Minister think about how the Government can encourage local authorities to ensure the safety, as well as the opportunities, of young people with learning disabilities and disabled young people?

Anne McGuire: I fear that the hon. Gentleman has fallen into the trap of assuming that making it safe for young people with learning disabilities to go to and from a place of training or employment automatically means a structural change such as the introduction of a pedestrian crossing. As those who work with young people with learning disabilities will know, a range of life skills can be developed in the circumstances that he has described. Of course, I do not know whether a pedestrian crossing is needed in his constituency; if that is the case, no doubt he will let us know.
	The Government have a manifesto commitment to
	"ensure that services are designed to meet the additional needs of disabled children and their families",
	and are engaged in a positive programme of work to improve the life chances of disabled children. The key objectives are to improve support for families with disabled children in line with the national service framework, to ensure that disabled children benefit from the development and expansion of early years services, to promote equality of opportunity through the Disability Discrimination Act 2005—which means improved access to schools, early years services and educational opportunities—and to deliver fit-for-purpose services that improve outcomes for disabled children. The aim is to move away from the idea that the provider always knows best what an individual disabled person or child would want.
	The hon. Member for Tiverton and Honiton (Angela Browning) spoke of disabled teenagers reaching the point at which they wish to move into adulthood, and to have some of the opportunities that their non-disabled friends, colleagues and family have. We have to recognise that disabled children and young disabled people have aspirations and ambitions, too. For too long, we almost wrote off their right to have those ambitions and aspirations. It is not the aspirations that are wrong; it is the barriers to meeting those aspirations.
	Sometimes, the reasons behind the barriers are not straightforward. They may be to do with a young person's health or impairment, but—this relates to something that the hon. Member for Upminster (Angela Watkinson) said—the attitudes of society play an important part. That is something on which we can all agree, and I know that that it was highlighted in the parliamentary report.
	As I said earlier, there is no doubt that we structure our services and the provision for disabled adults in a way that often meets the priorities of the providers, but I want to pick up on one or two other points made by the hon. Member for South-West Surrey. I was seriously disappointed by his comments on the Office for Disability Issues and by the fact that he suggested, or appeared to suggest in his press release, that there was a lack of ministerial commitment. In fact when he puts together all the parliamentary answers, including the one from me—I chair that meeting—he will find that there is serious ministerial commitment to that cross-ministerial group, with the caveat that occasionally, when a Minister cannot attend, that Minister sends a senior representative from his or her Department, so we are fully committed to disability issues through the ODI.

Jeremy Hunt: Can the Minister explain why the response to the parliamentary question that I put to the Department for Education and Skills, sent to the Under-Secretary of State, Lord Adonis, said:
	"I am responding on behalf of Lord Adonis, who leads on this area. There have been no meetings at ministerial level"—[ Official Report, 9 January 2007; Vol. 455, c. 563W.]

Anne McGuire: I have not seen the hon. Gentleman's initial parliamentary question, but I say to him and to Conservative Members that Lord Adonis has attended meetings of the cross-ministerial— [Interruption.] He has. As I say, I have not seen the original question that the hon. Gentleman sent. The Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), says from a sedentary position that it certainly was a real person, looking like Lord Adonis, who attended those meetings. I think that that is an issue that would be better resolved in another place. I want to give the hon. Gentleman an assurance that we are taking this very seriously. Ministers are taking it seriously.
	I will now look at some of the points that the hon. Gentleman made about benefits. We recognise that sometimes benefits and the procedure for benefits can be a barrier. That is why we are constantly investigating ways to improve our benefit delivery. We are working with the Child Poverty Action Group, Contact a Family, family and carers groups, and the Disability Rights Commission to examine how we can make the operational changes that will make the reaction to applications for disability living allowance for children more responsive. We are working with various other stakeholder groups on that issue.
	I also want to say to the hon. Gentleman that we have made significant changes in the amount of benefit that is paid to children. I do not want to scratch over old sores, but in 1997 children under the age of five could not apply for the mobility component of the disability living allowance. That was a rule made by his Government. We changed that, and now children can apply from the age of three. This is not old hat, and it is part of the reason why sometimes there is an element of shallowness in the way in which some hon. Members—excluding the hon. Member for South-West Surrey—come to the issue. In fact entitlement now to disability living allowance can start at the age of two years and nine months. The disability child premium has doubled since 1997, and the carers premium has also doubled.

Jeremy Hunt: Will the Minister clear up one puzzle? At the back of the application form for carers allowance, it says that one of the achievements is that in 2005-06 claims were settled in an average of 13.1 days, but the 2006-07 target for the average clearance time is 15 days, so the Government have set themselves a longer time to clear benefits in 2006-07. Why will that help to improve the service that the Government provide?

Anne McGuire: I am delighted to tell the hon. Gentleman why. I did have the option of reducing that target below 13 days, but I wanted to emphasise not how quickly we could get those benefits out of the door but the quality of the decision, and it was more important to emphasise the quality. I could have set an additional target, but if we were turning benefits around in 13.5 days I wanted to ensure that within those 13.5 days, we got a quality decision that stopped some of the appeals that he usually complains about.

Russell Brown: Will my hon. Friend give way?

Anne McGuire: I give way to the hon. Lady—I mean to my hon. Friend.

Russell Brown: I forgive the Minister for whatever she said there—I do not think it was derogatory. Hon. Members on both sides of the House would agree that the needs, wishes and desires of disabled people are complex. The hon. Member for South-West Surrey (Mr. Hunt), who speaks on behalf of the Conservatives, has talked about the amount of paperwork that needs to be filled in. I noted the article in  The Times yesterday and I have also looked at the Conservative website. There appears to be a move towards reducing the number of benefits, but I am deeply anxious. I do not know whether the Minister shares my concern. Does she not believe that rolling up all the benefits available to disabled people would create a more rigid system that would not be able to meet the diverse needs of disabled people?

Anne McGuire: I thank my hon. Friend for that intervention, because I think it is appropriate to bring that idea into the discussion at this point. I appreciate that superficially it sounds great to try to move towards a single unified benefit, but I want to give a word of warning to the hon. Member for South-West Surrey. The benefits for disabled people serve different purposes at different times. There would be a grave danger if we started to look at a single roll-up benefit, because we would be putting rigidity into the system. At the moment, we have a system with the disability living allowance that tries to be as flexible as possible to meet the needs of the individual. That is why there are different benefit strands and different questions. There is a grave danger that a rigid system would financially penalise some of the most vulnerable disabled people, rather than helping them.

Jeremy Hunt: I wonder whether the Minister could tell me how it helps the flexibility of the system if three quarters of the questions that have to be answered by parents of disabled children are asked at least twice.

Anne McGuire: I thank the hon. Gentleman for that lead-in to my next point. He and I and our Department are on the same wavelength on that. I noticed on the Conservative party's disability website that he was going to mention this tonight. Obviously he will have noted that the Secretary of State said earlier last week that
	"Public services must increasingly be based around the need of customers"—
	which reflects what the hon. Gentleman was saying—and that
	"A lot of progress has been made to tailor our services accordingly but current privacy procedures and working practices can sometimes still force people to have to convey the same information multiple times to different agencies."
	Again, I think that the hon. Gentleman and I are on the same wavelength.
	I then looked at the BBC News website and saw the headline "Tories attack data-sharing plans". The hon. Member for North-East Hertfordshire (Mr. Heald), who I understand is the spokesperson on constitutional affairs for the Conservative party, has severely criticised the very idea the need for which the hon. Member for South-West Surrey is highlighting tonight—that we must get ourselves to a situation where people do not have to keep giving the same core information to different Government agencies.
	So the hon. Gentleman might wish to speak— [Interruption.] No, the hon. Gentleman often talked about multiple questions being asked. As he has grave concerns in that regard, which we recognise, he needs to look at whether— [Interruption.] From a sedentary position, the hon. Member for Runnymede and Weybridge (Mr. Hammond) is still talking about the single benefit.  [Interruption.] Well, we were trying to start with the Department for Work and Pensions. Only last week, my Secretary of State highlighted the fact that we want to consider whether we can increase data sharing, and the Conservative Front-Bench spokesman on Constitutional Affairs said, "No way, Jose"—that is what the press release says. As the hon. Member for South-West Surrey has genuine concerns about multiple questions, he clearly needs to have a few words with his colleagues.
	Finally, I want to deal with some of the issues highlighted in the hon. Gentleman's comments on child poverty. He is right to highlight the fact that families with a disabled child, or a disabled carer or parent, are more at risk of poverty. The key factor in that is worklessness, as was discussed extensively in the Welfare Reform Bill Committee. That is why we have placed great emphasis on supporting into work disabled adults, many of whom are parents or carers. I have also referred to some of the success stories about lifting children—700,000 of them—out of relative poverty in the six years to 2004-05.

Angela Watkinson: Will the Minister give way?

Anne McGuire: I do not wish to be discourteous to the hon. Lady, but in fairness to other Members I should try to draw my remarks to a close.
	The review by the Treasury and the Department for Education and Skills—with support from other Departments, including mine—found that many programmes and initiatives are making a real difference, and that there is widespread good practice in delivery for disabled children and young people. However, as I said at the beginning of my speech, we recognise that that good practice is not yet consistent across the country. There are also a number of areas where more work needs to be done: ensuring that information on benefits gets to parents and carers at the right time—a point that was made by the hon. Member for Edinburgh, West (John Barrett)—improving knowledge and understanding of disabled young people, and disabled people generally, in the work force; developing a coherent and clearer understanding of the disabled children population; and further integration and co-operation between services. I hope that, through the Office for Disability Issues, we engage in joint working across government.
	Let me say something in a spirit of solidarity with the hon. Member for South-West Surrey: we all want the best for our children and for the next generation of young people in our country. This Government have committed unremittingly to giving disabled children and young people the right start, the right opportunities and the right support, to ensure that they have a bright future. Every child matters, and every disabled child matters—and although we might have differences on the approach to be taken, I hope that the hon. Gentleman will reflect on his party's motion and decides that some of the comments are rather harsh in the light of our record. I ask the House to support the amendment.

Danny Alexander: I welcome the opportunity to debate the important issues that are under discussion. Disability is a big issue for all Members and our constituents. As we have heard, many issues affect the life chances of disabled children, and they cut across the work of a number of Departments, which is why joined-up government, to which the Minister referred at the end of her speech, is so important, even though it might not always be as successfully delivered as we would hope.
	Having served on the Welfare Reform Bill Committee with the Minister and the hon. Member for South-West Surrey (Mr. Hunt), I had expected there to be a continuation of the positive tone that there was in Committee. I am a bit disappointed that that spirit has not been as much in evidence.
	A couple of issues are key in respect of the motion, and they need to be debated: first, poverty and particularly access to employment for parents of disabled children and the operation of the benefit system; and, secondly, the quality of services provided to disabled children.
	Reference has been made to the parliamentary hearings of last year that were chaired by the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), and at which my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) was very involved; I pay tribute to her longstanding work on the issues under discussion. At those hearings, children with disabilities and their families spoke directly about their concerns. A number of points that arose in those hearings have been put on the record, and I want to add a couple more.
	One recommendation was that disabled children and their families should have an opportunity to shape the way their services are planned, commissioned and delivered. It is important to understand that the issues we are discussing affect the whole family—not only the disabled child, but also the parents and siblings of that disabled child. It is also important to recognise that improving the life chances of disabled children has a significant impact on their life chances as adults as well, in terms of educational achievement then leading to employment and higher education, and so forth. These issues are not only to do with children; they are also to do with the entire life of a disabled person.
	It is worth returning to some of the key facts behind the debate. It started with a dispute about numbers in relation to the motion. However, regardless of what the exact figures are, a huge number of people across the United Kingdom are affected. In the UK, 7 per cent. of children and young people have a disability or limiting long-term condition—a total of 770,000. Of those children, 98 per cent. live at home with a parent or other family member. According to the figures that I have seen, each day in Britain 75 children are born with, or are diagnosed as having, a disability.

John Barrett: Would it not be a great help for parents of new-born children diagnosed with a disability if information were given to them very early on in a straightforward and simple manner? That would give them access at an early date to the benefits that they are entitled to.

Danny Alexander: That is right—and to me, as someone who will, God willing, in due course be welcoming an additional member to my own family, it is also particularly important.
	Charities estimate that it costs three times more to bring up a disabled child than it does to bring up a non-disabled child. In the UK, 3.6 million children are living in poverty—that is, 28 per cent. of such children—compared with 55 per cent. of disabled children who are living in, or on the margins of, poverty. It is important to recognise that poverty is not only likely to result from disability, but that it also might cause it. For example, children born into low-income families are more likely to have low birth-weights, which can lead to future health problems. The interrelationship between childhood disability and poverty is clear, and so are the consequences of that for the services that people consume.
	Of families with a disabled child, one in 13 receives support from social services departments. Disabled children are 13 times more likely to be excluded from school than non-disabled children, and eight out of 10 families with disabled children say that they are "at breaking point".
	So the clearest indication that disabled children do not have the same life chances as non-disabled people is the extent of poverty faced. Only some 6 per cent. of families with disabled children reported that they were "comfortably off". By way of contrast, 92.8 per cent. reported experiencing some kind of financial difficulty. It is important to talk a bit about the causes of such poverty. I shall come back to the extra cost of services, but there is also the question of the extra cost of living. Let us consider fuel poverty. Disabled children might have particular needs in terms of keeping the house warm, so turning down the heating, which many people are encouraged to do, is not an option. That expense simply has to be met, leading to greater fuel costs for the families of disabled children than those experienced by the general population. The proposal to extend the winter fuel payment to severely disabled people would therefore have some impact in this regard.
	There are a number of inadequacies in the benefits system, to which I shall return, but in addition to that issue and the cost of services, the other big barriers for families with disabled children are the barriers to work. This issue is not adequately addressed in the Welfare Reform Bill, and we perhaps need to return to it. For example, social care services, to which the hon. Member for South-West Surrey referred, often assume that parents can pick up any additional hours that such services cannot provide. That obviously impinges on parents' ability to work, especially full time, because there might be an unexpected requirement to provide care for their child when the system lets them down, thereby removing them from the workplace. That is reflected in the fact that only 16 per cent. of mothers with disabled children are in work, only 3 per cent. of whom are in full-time employment. By way of comparison, 61 per cent. of mothers of non-disabled children are in work. That is a huge disparity.
	Let me give a quotation from the "Every Disabled Child Matters" campaign. One mother of a disabled child said that
	"simply getting out of the house can be difficult. I spend all my time organising his different appointments. I used to work as a radiographer in the local hospital. I really enjoyed my job but I can't imagine I'll ever be able to go back, I'd never find the right childcare."

Maria Miller: The hon. Gentleman rightly refers to the difficulties that many parents with disabled children experience in getting out of the house. Does he share my concern that such parents are not eligible to apply for blue badges for their children if they are aged under two?

Danny Alexander: I certainly do share that concern. I had not intended to highlight it, but I am grateful that the hon. Lady has.
	The poverty and worklessness figures are even more worrying in cases where there is a disabled adult in the house, as well as a disabled child. According to the Department for Work and Pensions,
	"a household with a disabled child and a disabled adult is nearly twice as likely to have a low income"
	as a household with no disabled family members. That throws into stark relief the poverty-related problems that disability can often cause. According to the charity Working Families, 70 per cent. of parents with disabled children find it difficult to obtain appropriate child care. By definition, therefore, only 30 per cent. can find appropriate child care, which affects their ability to work as well as, importantly, the well-being of the child.
	The Liberal Democrat approach to these issues was set out very clearly by my right hon. and learned Friend the Member for North-East Fife (Sir Menzies Campbell) in his major speech on poverty in December. Like the Minister and the hon. Member for South-West Surrey, we have committed ourselves to supporting the target to eliminate child poverty by 2020. There has been a welcome reduction in child poverty under this Government but it has yet to go far enough, which, of course, is why the interim targets have been missed. For the reasons that I described earlier, tackling poverty among disabled children is now critical if the 2020 target is to be reached. We need a different approach. We need to move away from the mass-means-tested, complex and bureaucratic dependency system that we are increasingly seeing under this Chancellor of the Exchequer.
	Given the article in Monday's edition of  The Times, I, like the hon. Member for Dumfries and Galloway (Mr. Brown)—he is no longer in his place—had hoped that we might hear a little more from the hon. Member for South-West Surrey about the Conservatives' plans for reform. He was long on criticism, some of it legitimate, but there were zero policies for dealing with the reasons behind such criticism. It is a shame that the hon. Gentleman is hiding his light under a bushel. If the article in  The Times is to be believed, he and the hon. Member for Bury St. Edmunds (Mr. Ruffley) have submitted a lengthy policy proposal to a particular working group. I am surprised that the hon. Member for South-West Surrey did not take the opportunity to extol the virtues of that proposal. Perhaps the hon. Member for South-West Bedfordshire (Andrew Selous), who will wind up for the Conservatives, will do so. It is important in these debates not just to highlight problems, but to describe solutions if one can.
	In the absence of such efforts, one has to go back to the speech of the right hon. Member for Witney (Mr. Cameron). He looked at poverty issues more generally, and described an approach based on
	"rolling back the frontiers of society".
	That is not so much a big idea for the future as a small idea from the past—an approach that my right hon. and learned Friend the Member for North-East Fife referred to as one of "compassionate inactivity". In the absence of hearing more from the hon. Member for South-West Surrey, we have to assume that that is what he has in mind.
	There are some big issues to do with how the benefits system affects disabled people. I shall highlight one or two examples of the real experiences that disabled children and their parents have of the benefits system. According to the Child Poverty Action Group's "Out of Reach" report, some 46 per cent. of parents of disabled children
	"believe that they have missed out on benefits and tax credits because they have not been told they could apply".
	That is nearly half. Some 43 per cent. of parents of disabled children had not claimed disability living allowance or it had taken more than two years to find out that their child could be entitled to it. Those issues relate to both the adequacy and the complexity of the benefits system.
	On the issue of adequacy, the Minister made some fair points about the rising levels of benefit in recent years, but it is also true to say that the levels of most benefits have been progressively eroded in recent years.

John Hayes: My hon. Friend the Member for Upminster (Angela Watkinson) mentioned earlier the Rose project in Havering, which is run out of Havering college and allows disabled young people with moderate or severe learning disabilities to access work. One of the disincentives, also mentioned earlier, is that they can sacrifice benefits. The Minister dealt with that point, but a second disincentive is that once they come off benefits it is very hard to go back on. They sometimes will not seize opportunities put before them for that very reason.

Danny Alexander: The hon. Gentleman makes an important point. The linking rules for certain benefits have been improved in recent years, which means that people can spend a longer period in work before going back on benefits. For incapacity benefit, for example, the period is now two years. However, whatever the rules are, they are often not explained properly to the people in the circumstances that the hon. Gentleman mentioned. In the absence of proper information and understanding, the fear of losing benefits is a powerful demotivating factor for people who otherwise wish to get back into work. When one talks to disability groups, the enormous desire of disabled people to get back into work is evident, but they are frustrated by the lack of support available and the disincentives in the benefit system. Those disincentives also include the marginal deduction rates, which can lead to some people on low incomes facing effective income tax rates of 70, 80 or even 90 per cent. when they go off benefit and into work.
	Instead of allowing benefits to wither away in relation to earnings, we need at least once in every Parliament to hold a review of benefit levels against objectives for poverty reduction, although of course—I am conscious that my hon. Friend the Member for Falmouth and Camborne (Julia Goldsworthy) is in her place—that must be in the context of public spending discipline and the overriding need to help people back into work.
	The hon. Member for South-West Surrey rightly highlighted the issue of complexity. The forms are clearly a nightmare and provision of information about benefit entitlement is massively inadequate. It was disappointing that the Government refused to accept an amendment to the Welfare Reform Bill that would have made it explicit that information about all benefits to which someone might be entitled should be made available to them at the time of their first claim. That would be a big step in administrative terms towards solving some of the problems.
	It is also true to say, as the hon. Gentleman pointed out in  The Times, that the system is too complex : there are 51 benefits, with 250 different rates. Conceptually, benefits have two roles—first, to meet extra costs, for example in relation to the extra costs of having a disability; and secondly, to replace lost income when someone is out of work, for whatever reason. On the latter role, the case for a single working age benefit—a single benefit level to replace the lost income of someone out of work for whatever reason—is quite powerful. The New Zealand Government are pursuing that approach at the moment and I hope to be able to say more about it in the next few months. Such a single rate would release additional funds to be added to the extra costs elements, such as the disability living allowance, so as to beef them up.
	One of the limitations of DLA is the restrictive number of components in terms of care and mobility. A communication element could bring the DLA into the 21st century. However, I am not convinced that a single disability benefit alongside a single working age benefit would be as attractive, but I look forward to hearing more of the hon. Gentleman's arguments. Disability is a very wide spectrum indeed. The word "disability" covers a huge range of different conditions and impairments. Although we must get rid of the complexity when it comes to filling in forms that causes so many problems for so many people, we must also ensure that that does not create a less variegated system.

Annette Brooke: Ministers constantly assure us that they are looking at the complexities of the forms, but does my hon. Friend share my surprise that nothing seems to happen and that the forms are still 23 pages long, or longer?

Danny Alexander: I certainly do share that very important concern. It may be that Ministers struggle to read through the forms and guidance as much as anyone else does, and that that is impairing their ability to reform them. The Minister said that the matter was being considered with some urgency.

Anne McGuire: I can give the hon. Gentleman some news. We have developed a new form for disability living allowance, and it has been road tested with people entitled to that benefit. It has received a very positive response, and will be rolled out when appropriate.

Danny Alexander: That is probably good news, and I welcome the Minister's immediate response to the pressure that I applied to her. It would be useful if she could deposit copies of the new form in the Library of the House, so that hon. Members can judge its length and degree of complexity, but it is good to hear that, after nine years, the Government are taking the matter seriously.
	I want to touch on some of the issues to do with services for disabled children that the hon. Member for South-West Surrey mentioned in his opening remarks. It is important to make it clear at the outset that we are not dealing with a homogenous group, as every disabled child needs his or her own package of services. Therefore, support services such as respite care or therapy should not be regarded as luxuries for disabled children and their families. For many children with specific needs, such services are necessities.
	The Minister referred in her remarks to the social model of disability. In that context, we should take "services" to mean anything that helps children to live independent and normal lives and ensures that they do not miss out on any experience enjoyed by children who are not disabled. Parents of disabled children often say, "Our children have the right to have fun, like any other child." That is as important in this debate as any of the service provision that has been mentioned so far.
	I have listened with interest to the constituency cases that have been described. It is true that the system sometimes discriminates against families who are unwilling or unable to fight or shout loudly, or to pay independently for services, assessments and legal support. For example, information about services is less likely to reach families from ethnic minority communities.
	I am conscious of the time, so I shall end my remarks by saying that although all hon. Members are very aware of the needs of disabled children, we must do more than introduce policies in the piecemeal fashion of the past few years. Instead, we must look across the system to determine how we can introduce more thoroughgoing reforms, so that the interests of disabled children are placed at the top of our agenda.

Joan Humble: Last May we debated, on a motion for the Adjournment of the House, the No. 10 strategy unit report about the life chances of people with disabilities. My hon. Friend the Minister and the hon. Member for South-West Surrey (Mr. Hunt) were to be found in their respective places, the report was excellent and well informed, and our debate was 99 per cent. good natured.
	I am a little saddened, therefore, that we are debating the subject on an Opposition day, because it has led to some adversarial comments and criticisms of political parties on both sides of the Chamber. This debate is too important for us to be point scoring. We should all be working together in the best interests of children with disabilities and their families, for the reasons that many contributors have already given—there are real concerns.
	As we have already had some arguments about figures, I am reluctant to cite numbers, but I will anyway. Since 1975, children aged 0 to 16 have formed the fastest growing group of disabled people. In 1975, there were 476,000 such children; now there are 772,000, which represents an increase of 62 per cent. Those demographic changes are one of the reasons why there are so many pressures on services for children and their families. There has been an increase not only in the number of children with disability but also in the nature and profundity of disabilities. Young people born with severely handicapping conditions now survive childhood and into adulthood, and good luck to them. I am pleased that medical advances enable them to do so, but there are huge pressures on the families and life style of those children.
	There is much data about that group, which highlights the pressures on families. Last year, the John Grooms inquiry into the needs of young disabled people produced the report "Young, disabled and forgotten". Less than two weeks ago, we received the report, "The state of social care in England 2005-06" from the Commission for Social Care Inspection, which discussed services for children with disability and council expenditure. Last week, the Treasury and the Department for Education and Skills published its review of services for children and young people, which included a detailed section on the needs of children with disability.
	The report I particularly want to discuss was produced by my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), me and several other Members, supported by a consortium of children's charities—Children Now, Contact a Family, the Council for Disabled Children, Mencap and the Special Education Consortium. The Government had previously recognised the importance of the issue. My right hon. Friend the Chancellor announced that the comprehensive spending review would include consideration of
	"how services can provide greater support to families with disabled children to improve their life chances".
	My right hon. Friend the Member for Coatbridge, Chryston and Bellshill and I were pleased to be asked to contribute to the review, and we invited Members from all political parties to join us. With the support of the consortium we set about organising hearings at Westminster, which produced powerful testimony from parents about the pressures they experience.
	It is abundantly clear that disabled children do not enjoy the same life chances as other children, so it is vital that all the reports lead to positive action. Before I set out the key recommendations arising from the parliamentary hearings, I want to pay tribute to the Government for their work. Much has happened over recent years. The Office for Disability Issues was set up, with the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Stirling (Mrs. McGuire), as the lead Minister. There are new disability equality duties for public authorities. There is a 10-year child care strategy. The Childcare Act 2006 prioritises the needs of disabled children and the children's national service framework specifically refers to disabled children. As the recent CSCI report points out, there has been substantial financial investment by the Government in social care for children.
	The report notes that there was a 10.1 per cent. increase in funding for family support services between 2003-04 and 2004-05, and a 7.1 per cent. increase in children's social work, although it does not say how much of the increase for children's services is for services for children with disability.

William McCrea: Does the hon. Lady know what happens in Northern Ireland when a young person with profound learning disabilities—and, quite often, physical disabilities as well—reaches the age of 19? If they are not going into employment, their education completely stops. They have a body of 19, but a mind of perhaps a five or seven-year-old. What other child does not receive education—or have the right to receive it—at the age of five or seven? Is that equal opportunities?

Joan Humble: I freely admit that I am no expert on the education system in Northern Ireland, but I will come on later in my contribution to talk about the problems associated with the transition from children's to adult services, as important issues also arise in the rest of the UK.

William McCrea: It is not a matter of adult services. The person I am talking about has a mind of a five or seven-year-old. They may be 19 years old, so an adult age will be recorded on their birth certificate, but in reality it is children's services that they need.

Joan Humble: The hon. Gentleman is absolutely right. When I talk about the transition from children's to adult services, I do so because our services have age limits applied to them—and they can be arbitrary, particularly when we are talking about people with disabilities. As the hon. Gentleman so rightly says, some 19-year-olds with disabilities are, to all intents and purposes, children, while others of the same age may have high intellectual abilities. They may have a physical disability, but be more than capable of dealing with the world of work or the world of further or higher education. One of the key messages that should come out of our debate is that we must take account of individuals. Everyone is an individual; we are all individuals. A young person with a disability is most certainly an individual and should be listened to on that basis.
	For that reason I welcome the Government's £13 million investment in the early support programme pilot, which has produced some very good work. A further £27 million has been invested in children's hospices. Brian House children's hospice is in my constituency, so I know that it does excellent work. I thank the Minister for what she has provided, but I would add a brief postscript of "more please". That investment has also been matched by a huge increase in expenditure on education.
	Key questions nevertheless must be asked. Is there enough money in the system? Is it being spent in the right way and is it going to the right people? Are the Government's excellent policies being implemented and are they changing people's lives? When I hear Ministers tell us how much money has gone into the system, I accept it, but I hear from my own constituents—and some Members heard from the parents at the parliamentary hearings—that they often do not see much evidence of it. We therefore need to look more closely into where the money has gone and why some families clearly have difficulty accessing the services that they need. The hearings clearly showed that a family with a disabled child is more likely to be poor, more likely to face barriers to work and barriers to the enjoyment of the many everyday things that we take for granted—holidays, visits to the cinema, visits to the park and so forth. What those people wanted more than anything was to live ordinary lives, to be socially included, to have equity in services and support.
	Poverty and the additional costs of disability put enormous pressure on families. A Contact a Family survey of 2004 showed that only 6 per cent. of disabled families reported being "comfortably off", with 92.8 per cent. reporting some form of financial difficulty. The support that families need to improve the life chances of disabled children is not just about appropriate care, education or housing; it is about improving the family income, jobs and the child care provided by well trained individuals who understand the needs of their disabled children. It is a hugely complex issue.
	We considered all those issues in our report. We produced a list of recommendations that my hon. Friend the Minister has looked at, and she will have seen that No. 1 is the need for significant additional funding, but that funding must be targeted at disabled children and their families. I very much hope that more money will come from the comprehensive spending review, but it should be given in an open and transparent way, as an investment in services, with clear obligations on service deliverers to show where the money has gone.
	The hon. Members who put together the report hope that a care offer will be developed to create a universal entitlement to a minimum service. We also recommend that the key worker schemes should be extended beyond the excellent early support programme. Families with children with disability need those key workers, and if their children have complex needs, they need them all the way through to the transition to adult services.
	One very important issue for many of those families is the provision of short-break services. According to the Treasury review, 3,000 children are on waiting lists for family-based short breaks. CSCI's figures for 2005 show that only one in 13 disabled children receives regular support services, including short breaks and direct payments.

Annette Brooke: Does the hon. Lady agree that the provision of short respite breaks very much represents investing to save if it holds the family together, avoids a child being placed in residential care and perhaps keeps the parents' relationship together? Surely, that is such a saving overall to society that that money is well spent.

Joan Humble: I absolutely agree with the hon. Lady. Short breaks are useful to the child; they are useful to the parents—they are often a relationship's lifesaver, as she mentions—but they are also important to other children in the family. We sometimes forget in debates on families with children with disability that they often have non-disabled children as well, and those siblings are all too often forgotten because their parents understandably concentrate on the child with disability, yet the other children also need some of their parents' love, affection and time, and short breaks and respite care give them that, so they are essential for everyone concerned.
	In an intervention on the Minister, I mentioned advocacy services, and I declare an interest as the president of Blackpool Advocacy. I see how important advocacy services are, because families with children with disabilities do not always have the voice to speak for themselves—they do not understand some of the issues—and they need someone else to express that voice for them. There are also instances when children, especially as they become adolescents, want to be heard. Sometimes, they want something different from what the rest of family wants. Again, their voice needs to be heard, and advocacy services should be a key part of the development of future services for children with disability.
	I agree with the hon. Member for South-West Surrey that benefits need to be simplified. It is not just that benefits for families with children with disabilities are complex, but sometimes the families do not understand what the benefits are supposed to deliver. There is a huge amount of misunderstanding about what disability living allowance is given for.
	Again, I declare an interest: Warbreck House in Blackpool is the headquarters of the disability living allowance unit, and I speak to the staff who deliver the service and do the assessments. Sometimes they get people claiming although they do not have an entitlement because they think that the benefit is paid as compensation for disability. It is not; it is paid for the social care needs that arise from the disability, and much more publicity is needed about what is available to families.
	Why do families who have children with long-term conditions that are not going to vary over the years have to keep reapplying? Surely disability living allowance could be given to some of those families for a longer period. I applaud the Minister for the references to the subject in the 2006 annual report of the Department for Work and Pensions, "Opportunity for all". In that report, the Secretary of State emphasises the need to "improve support for families",
	"ensure disabled children benefit from the development and expansion of early years' services"
	and "promote equality of opportunity". This is yet another report that details the needs and says what should be done. The question is whether those things are being done. Are families with children with disabilities being helped to go through the complex benefits system in the way that they should be helped?
	Finally on the recommendations from our report, I want to say a few words about the transition to adulthood. Parents who have children with disabilities, unlike most other parents, find that they are under more pressure, not less, when their child reaches adulthood. Even parents who have managed to obtain work when their children are at school, and who have managed to obtain good quality child care, often find that, when the child is 18 or 19 years old and is looking for support through adult provision, that support is not there or is not there full-time. Those parents often have to give up work to look after their adult child, at a time when many other parents are waving goodbye to their adult child, who is going off to further or higher education, or to work, and who is setting up in their own establishment. We have to look carefully at what support services are available to young people of 16, 17 or 18 who still need support. At the same time, we have to recognise that, as some young people with disabilities move into adulthood, they are very capable of living on their own—perhaps with some support—and going into the world of work. It is a case of looking at the needs of the individual and assessing those needs within the family, and doing everything that we can to support them.
	On top of that, there are many basic day-to-day problems. For example, the organisation Whizz-Kidz highlights the shortage of mobility equipment and the need for effective wheelchairs that do not just meet clinical needs. All too often when a child goes to hospital and there is talk of getting a wheelchair, people look only at clinical need. But that child will also want independence. They will want a wheelchair that can take them out and about, and that will enable them to go out with their friends. We need to look at effective mobility equipment and communication aids. I keep emphasising the importance of listening to the child, but some children need communication aids to express their opinion. Language barriers for children from ethnic minority communities need to be addressed.
	The policy review document from the Treasury and the Department for Education and Skills goes into great detail in all those areas, just as our own parliamentary hearings did, and finds examples of good practice, but also a lack of consistency and uniformity. We must build on the good practice that is identified, offer a universal service starting with effective early intervention, use key workers to advise families, and ensure that there is a coherent multi-agency approach all the way to adulthood, delivered by well-trained staff. The Treasury review ends its section on better outcomes for disabled children by saying:
	"In the light of this evidence, the Review will consider further what action needs to be taken to improve outcomes and equality of opportunity for disabled children and their families."
	We know what needs to be done. That review highlights a lot of what needs to be done.

Tom Clarke: I apologise to my hon. Friend for intervening, particularly as she is making an excellent speech and has almost concluded it. Her input into the review was first class and comprehensive, but does she agree that this is perhaps not the right debate in which to have a full discussion on the report, "Policy review of children and young people: A discussion paper", and will she join me in calling for a debate on it in Government time? The paper is so important that I am sure that the House would welcome that opportunity.

Joan Humble: I certainly endorse my right hon. Friend's call for a debate in Government time. The Treasury-DFES review is an important document, because it will feed into the comprehensive spending review. Those of us who argue for more provision need to debate it in detail and to urge Treasury Ministers to accept that we must invest in services, and the document is a key part of that.
	I want the recommendations that we made to the Government in our report and the failures outlined in the Treasury review to be addressed sooner rather than later. In a joint meeting of four or five groups, including the all-party groups on children, on child care and on learning disability, I told Lord Adonis that we need a short-term, a medium-term and a long-term strategy, and I say the same to the Under-Secretary. Then we could move in the right direction, and show parents that we were doing so, having recognised all the information that they gave the Government about their needs.
	Finally, lest anyone should think that I see disabled children as a problem, let me point out that they are not; they bring joy as well as pressures to their families. In the foreword to the report on parliamentary hearings, my right hon. Friend the Member for Coatbridge, Chryston and Bellshill and I said:
	"Disabled children have huge potential. The role of services for disabled children is to help children achieve that potential, and to allow their families to lead ordinary lives."
	That is the task before us, and it is one on which we must deliver.

John Bercow: I begin by declaring an interest as the father of a child who has significant, and probably long-term, special educational needs. It is a privilege to follow the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), because she speaks with integrity and authority on the issues that we are discussing. I also pay warm tribute to my hon. Friend the Member for South-West Surrey (Mr. Hunt), who offered the House both a forensic dissection of some of the failings of the system and a philosophical framework that will inform the policy of the next Conservative Government, and I congratulate him on that.
	As chair of the all-party group on speech and language difficulties, I would like narrowly to focus my remarks on the 1.2 million children whose disability is to suffer from a speech, language or communication impairment. Each and every right hon. and hon. Member in the Chamber is familiar with, and probably signed up to, the doctrine and mantra of ensuring that there is earlier intervention to address such impairments. We all know the consequences of effective early intervention, and the dangers of its absence. Let us take a child with initial speech, language and communication impairments. If early intervention takes place and is focused and effective, a child with relatively moderate difficulties will be able to read, spell and communicate by the age of five and a half. However, the consequence of the failure of that early intervention, which is an essential prerequisite for recovery and progress, is bleak indeed. Some of the consequences for a child who does not get the benefits of that early intervention are, of course, obvious. Later interventions, because time has been lost, will probably have to be more intensive, and will necessarily entail a greater cost. It is likely, as others have pointed out, that the problem will deteriorate and the condition will worsen so that instead of suffering from a significant but transient condition, the child unfortunately suffers from an impairment that is significant, persistent and even insuperable.
	I want to reflect on the consequences for children in such circumstances of the absence of early intervention. There are huge risks, both to the child and to the country. The risks to the child are well known, but they must be underlined so that they are at the forefront of ministerial and other minds in the discussion of public policy. There is a risk of emotional and psychological difficulties; of poor behaviour; of lower educational achievement; of a persistent handicap in communication; of deteriorating employment prospects; of serious challenges to the individual's mental health; and, yes, there is a notable risk of descent into criminality, of which the individual denied services and the country as a whole are the hapless victims.
	I said that there was a problem not just for the individual but for a society as a whole, and it can be viewed in economic terms. I calculate that the lifetime cost of denying effective assistance to the present primary school cohort with language and communication impairments is £26 billion. Without early intervention to address their disability and offer them hope and the prospect of progress, they suffer an economic loss in earnings potential and societal contribution which I CAN calculates to be worth £97,000 per person. In Milton Keynes, Buckinghamshire and Oxfordshire, 2,063 people fall into the so-called NIET category—not in education, employment or training—and 1,000 are in that position as a consequence of speech, language and communication impairments that have not been addressed, which is a very serious state of affairs indeed.
	We must reflect on the public policy required to address the problem. I do not want large numbers of people to be consigned to unemployment, disability and continuing dependence, or to be deprived of opportunities and denied a chance to contribute effectively to the society of which they are part. They want to assert themselves, to achieve, to be independent, and to prove how much they have to offer, both for their own self-fulfilment and for the benefit of society as a whole.
	I wish to identify, in as non-partisan a way as I can—and I think that the record shows that I generally do so—a number of issues that must be dealt with if we are to address the disabilities of those children and of others. First, may I tell Ministers that there is a fundamental weakness and conflict of interest at the heart of the special educational needs system? The local education authority, as my hon. Friend the Member for South-West Surrey said, has long been in a position of virtual omnipotence, which is an unsatisfactory and indefensible state of affairs. To put it simply, the LEA assesses, decides, pays for and, more often than not, provides the services to meet the assessed needs of the individual disabled child. That seems to me to be fundamentally wrong. It logically follows, as parents—including myself, know from our personal testimony and experience—that when we are seeking a statutory assessment, when we are successful in obtaining a statement of special educational needs, when we are arguing about the precise contents of that statement, or when we are fighting our corner to secure its effective implementation, we are up against an authority that has been in the driving seat throughout the process.
	That is wrong, and it is not only my view—it is the view of an authoritative body, after considered reflection and detailed study of the available evidence. I refer, of course, to the Education and Skills Committee, so ably and independent-mindedly chaired by the hon. Member for Huddersfield (Mr. Sheerman). Its report was clear that that system needed to change. My own view—and I will not rehearse the detail or the intricacies of the system tonight—is that we need to move towards a system for the delivery of special educational needs, including the determination of eligibility for statements, which is independent of Government, of local education authorities, of the source of funding and of the means of supply. Unless and until we get to that point, there is a lacuna in the system, which I readily concede has applied under successive Governments. The fact that we as a country got it wrong in the past should not in any way cause us to shy away from the issue or abdicate our responsibility.

Tom Clarke: The hon. Gentleman is making an inspiring and extremely well informed speech. May I reassure him that when our review considered these matters, including the recommendation of the Select Committee, we unanimously endorsed that recommendation? I hope that he will find some comfort in that view.

John Bercow: I am extremely grateful to the right hon. Gentleman. That is consistent with the non-partisan spirit that ought, as far as is possible, to inform these debates, and has certainly characterised the discussions that I have had with the right hon. Gentleman over a period of nearly a decade. It was an incisive intervention which happened to help my cause, and I am grateful to him.
	We talk, as I said, about early intervention. In very broad terms admitting of some oversimplification, one can categorise the debate in terms of deciding what is needed and then ensuring that it is available. On the subject of determination, I believe that we suffer continually in this country from a problem of late assessment, late identification and late diagnosis. I recognise, as the Under-Secretary of State for Work and Pensions, the hon. Member for Stirling (Mrs. McGuire) would argue if I did not, that in the case of a child there is a process involved, that development can proceed at different rates, and that it is legitimate to allow for periods in which changes in behaviour or performance can be achieved. However, I believe that sometimes those operating the system play precisely upon the hopes, as well as the more exaggerated fears, of some parents by saying, "Don't worry. There's plenty of time." Of course, those who are articulating that message very often have a reason of financial self-interest for holding back the provision of what is needed. I say to the hon. Lady that there is a problem in that regard.
	There are magnificent people working in the public service for disabled children. I think, for example, of health visitors, early years workers, teaching assistants and qualified teachers. Therefore, it might be politically incorrect to say what I am about to say, but, notwithstanding their experience and their dedication, they are not always remotely well trained or equipped specifically to identify the range of impairments from which children can suffer. We all know of stories from all parts of the House of people who had to wait two, three or four years to get the assessment that is needed. I know of a recent case that was highlighted to me by the National Autistic Society of a child whose diagnosis was incredibly late and who suffered grievously in consequence. We know that one in five schools does not possess a single teacher who has had more than a day's training in the phenomenon of autism. That person is inevitably not well equipped to identify the difficulties, still less to offer a prescription.
	I suggest a practical way forward. Let me ask the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who will respond on behalf of the Government, why not listen to the view of the Association for All Speech Impaired Children, of which I am fortunate recently to have become a patron? It made a submission to the Treasury review on services for disabled children. It suggested the development through specialist expertise of a particular screening test that would help at an early stage in a range of schools to identify who suffered from which impairment and how that child might best be helped. A speech and language therapist could develop such a test at a relatively modest cost, and the expertise could then be spread across the piece.
	We must also take account of the problems that result from lack of capacity. I appreciate that the Government have invested significant resources—I respect that, applaud it and believe that some benefits can flow from it. However, a difficulty remains. If a child is integrated into mainstream education, with no additional provision or frills because the impairments are judged to be relatively modest, so be it, but we must still ensure that trained staff are readily accessible to deliver assistance of a quality, in a quantity and at a time required. That does not always happen.
	Schools have language units attached to them that often provide for children with somewhat more pronounced difficulties. Again, I declare an interest because my son started school at such a facility last week, and I have high hopes of what might be achieved there. We need more of them and we must ensure that there is a quality team available, preferably in the school. I should like a speech and language therapist to be based in every primary and secondary school in the country. However, when that cannot happen, we need training for people and peripatetic provision of considerable intensity at regular intervals. We must define what we mean by "regular" for individual pupils.
	At the severe end of the spectrum, we must ensure either that we have highly qualified local people who can deliver and develop capacity sufficiently to ensure that every child gets what is necessary or we have to go for something else. We must have regional centres of excellence and the use of expertise, the better to cater for such difficulties.
	The Under-Secretary knows that in "Every Child Matters", the word "specialist" is used no fewer than 32 times. In "Removing Barriers to Achievement", it appears 68 times. He knows that in 2002 the Audit Commission deplored the shortfall in specialist provision and that the Government have said that there must be high quality, intensive, local provision available before a decision is made either to reduce places in a special school or to close whole institutions. I emphasise the importance of that in the context of dealing with low incidence, serious, persistent, complex and multifaceted impairments.
	The Government have done some good work, but there are genuine weaknesses in the system that need to be tackled. In my judgment, too many children have suffered too much for too long. They get too little, too late and the recovery that then has to take place is an enormous challenge for them, their families and the educational system. Let us resolve to go forward, improve policy and ensure that every child gets the best deal that can be offered.

Lynda Waltho: The debate so far has been interesting and informative and I am genuinely surprised by what appears to be an attempt by the Opposition to shake off the "nasty party" image and to embrace a more enlightened approach to social policy. I am sure that the hon. Member for South-West Surrey (Mr. Hunt) would agree, however, that in order to be taken seriously the change of image needs to go right down to the grass roots, where the decision takers are taking decisions that affect the life chances of disabled children.
	Unfortunately, the enlightenment that has been expressed today is certainly not being felt on the ground in my constituency and in Dudley. I appreciate the non-partisan way in which most of the debate has been conducted but, on behalf of the disabled children and the parents of disabled children who come to my surgeries every week, I need to highlight some issues that I am experiencing as the Member of Parliament for Stourbridge. This is not just about money; it is also about services and about everything that makes up and goes towards a child's life. I should like to give a few examples of how those children's life chances are being affected by the cuts in services that are now being made by Dudley council.

Rob Marris: A Tory council.

Lynda Waltho: Unfortunately, yes.
	The first issue relates to transport for disabled children. Just two days before the Christmas break, my office suffered a deluge of calls from worried parents and from staff at local special needs schools. The day before, they had been told that there was to be a review of the transport for children to their schools and that they had until 15 January—barely a week after they got back from the Christmas break—to get an appeal together to take to what sounded like a kangaroo court. The decision on why the children should still receive this transport was nothing to do with their statement of needs or their annual assessment.
	Tonight, there has been a report on the matter in the local paper. It reads:
	"Plans to scrap free minibus places to take youngsters with learning difficulties to and from Dudley schools have been shelved in 20 cases—with more than 60 still awaiting a final decision. Plans...to save cash by taking away free transport for the youngsters, some of whom have to travel miles to get to special schools...were revealed in December. The move"—
	was—
	"initially thought to affect 70 pupils, although the figure is now closer to 90."
	This has caused a tremendous amount of stress over Christmas and the situation is now getting worse.
	Two weeks ago, we heard about a cut to voluntary services for youth services, which will affect disabled youngsters. The What? centre in my constituency, which gives counselling to all youngsters, still does not know whether its grant will be re-established from March. The Orchard centre provides play schemes for disabled youngsters and respite and back-up for families. Last year, it took two to three months of correspondence and meetings to ensure that its grants from the council continued. That is despite yet another increase this year in the money coming from the Government to Dudley council.
	It is coming up to the 9.30 break, so I shall not go on, but I think that hon. Members are getting the picture. I have worked with children with special needs, and the last time I did so was under a Tory Government and a Tory local regime. That was very difficult. Now that I am the MP for the area, I am coming across cases that are showing me that there has been no change. Therefore, I hope that what appears to be a genuine approach by the Conservatives to walking towards enlightenment will actually go down to the grass roots. I would really appreciate any intervention or assistance from the hon. Member for South-West Surrey in enlightening the local councillors on Dudley council.

Andrew Selous: We have had a mainly thoughtful debate on the opportunities for the United Kingdom's 700,000 or so disabled children. We have heard about complexity in the benefits system, duplication in parts of social services and inflexibility in parts of the education system. That all results in a less than fully effective use of taxpayers' money, which means that we are not reducing child poverty as fast as we would like, that the quality of life for disabled children, their families and carers is not as high as it could be, and that the opportunities open to those children are not as great as they should be.
	Last week I had the pleasure and privilege of visiting Hillcrest special school for children with severe learning difficulties in Houghton Regis. The school is very well regarded, and I pay tribute to its staff, and especially to its excellent head, Peter Skingley. I spent my time at the school speaking to a large group of parents and staff about their day-to-day experiences of caring for disabled children. A mother of three children with complex needs told me how, 19 years after first coming into contact with services for disabled children, she and others like her are still fighting for the same things. Recently, their experiences have included fighting for two years even to get a diagnosis, fighting to get a child into the right school, battling for 18 months or more with a tribunal and feeling that they were not being listened to, and waiting for three years to get respite care following the closure in 2003 of Appledore, the only local home in the south of the county providing respite care for children with complex needs.
	Both Government and Opposition Members should feel admonished by what those parents had to say. I must say to Ministers that I am a little surprised that the Government amendment is not more realistic about the day-to-day experiences of such parents. Instead, it congratulates and commends the Government on their achievements no less than three times.
	Parents say that no one tells them what is available. The provision of a checklist of social security benefits, care services, school placements, health services, disability aids and adaptations and respite care, perhaps by local primary care services, at the start of a disabled child's life, should be automatic, would cost virtually nothing and would prevent years of missed benefits and services. To his credit, that is a point that the hon. Member for Edinburgh, West (John Barrett) has raised on more than one occasion in the House.
	Last June, a nurse consultant from Bedfordshire Heartlands PCT came to see me to ask my help in dealing with the multiple assessments undergone by disabled adults and children, which cause difficulties for all concerned. As a start, within the Department for Work and Pensions, information on existing databases could be shared, thus saving money that would be spent on creating a new database. I commend my hon. Friend the Member for South-West Surrey (Mr. Hunt) on the comprehensiveness with which he described the multiple assessment process that applies across Government and also encompasses many local authorities.
	The issues that we are dealing with range across several Departments. At the moment there is no Minister from the Department for Education and Skills on the Treasury Bench. I am disappointed about that, as I understand that it is the lead Department, and I want to raise the issue of parents who do not know that their disabled children have been physically restrained at school. I have mentioned the subject in the House before, in the presence of the Minister for Schools. My personal view is that all parents should be told promptly, ideally on the same day, if their child has been physically restrained at school.  [Interruption.] Ministers say "Obviously", but there is only voluntary guidance on the issue. There is a circular known as 10/98 from the Department for Education and Skills which strongly recommends that that should happen, and one or two local authorities—one is St. Helens in Merseyside—make it mandatory throughout maintained schools in their LEA areas.
	Members can imagine how serious the situation is for disabled children who cannot tell their parents what happened to them at school that day. My hon. Friend the Member for Buckingham (John Bercow) spoke movingly and powerfully, as he has on many occasions, about the specific needs of children with speech and language difficulties. I commend him for doing so, as I am sure do all Members. Like, probably, everyone who heard him, I was particularly shocked to learn of the proportion of children in his area who are in the "not in education, employment or training" category because of speech and language difficulties. I think that we are all concerned about speech and language therapy, and that statistic alone was highly valuable.
	I mentioned physical restraint because of two cases made known to me recently. In one case, a mother only realised what was happening because her child came home from school with tears in her jeans. In another case, a severely autistic child was only able to tell his parents what had happened to him at school a year or so after the event. That is now the subject of an investigation, not before time.
	Teachers at special schools have expressed concern to me that there is no longer any initial teacher training for those who want to work with special needs children. I understand that there was such training about 20 years ago. There is now a danger that when the current cohort of special school heads and senior staff retire, the teachers who replace them will not have benefited from the initial training. That was mentioned to me specifically by Peter Skingley of Hillcrest special school, and I think it is a valid point. I am glad to see that an Education Minister is now present, and I hope that he will convey that point to his Department.
	The transition from children's to adults' services was raised by my hon. Friend the Member for Tiverton and Honiton (Angela Browning) in an intervention, and also by the hon. Member for South Antrim (Dr. McCrea). Parents to whom I have spoken locally have raised with me the timing of the assessment involved. It often happens extremely late, just before the transfer, which causes all manner of worry and stress to parents and families.
	A transfer might involve an assessment of, for example, a young person wishing to proceed to a college of further education. If it were not carried out in good time, that young person's chance of getting into the college might well be affected. Indeed, on the subject of education, the issue of special needs places in FE colleges has also been raised with me. Again, I would be grateful if the Department for Education and Skills would look into that. There is no reason why those assessments could not be done a good 18 months to two years in advance of the transfer. That would be sensible. There would be no extra cost involved, and it would reduce the stress for all concerned.
	I am sorry that we did not have the chance to hear more Back-Bench speeches tonight. There has been some criticism of the fact that this has been the subject of an Opposition day debate. I do not take that view. These matters are so serious that any opportunity to debate them in this Chamber is valuable.
	We have had some constructive suggestions as to how we can take a number of those issues forward. It is the contention of my hon. Friends, and indeed many other hon. Members, that in some cases it should be possible to organise services for disabled children more effectively than is being done at the moment. I hope that there will be an honest recognition of that from Ministers. Those outside the House who are watching this debate or will read transcripts of it afterwards are looking not for party political point scoring but for a realistic appraisal of where we are now, and positive practical proposals to improve the opportunities for disabled children. We want constructive debate, because for the children, their families and carers, these issues are too serious for anything less. That is the point that my hon. Friend the Member for South-West Surrey, the shadow Minister for the disabled, made tonight.
	I am delighted that we have had an opportunity to debate these matters. We need to continue to do so. I commend the work undertaken by the two Labour Members who have spoken. I am pleased that we heard, by way of an excellent speech, from the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) and, by way of a series of interventions, from her colleague, whose constituency name—he must forgive me—momentarily escapes me. He was one of the co-organisers of the parliamentary hearings. I pay tribute—

Tom Clarke: As the right hon. Member for Coatbridge, Chryston and Bellshill, I am grateful to the hon. Gentleman. If I gave the impression that I thought this subject was inappropriate for such a debate, that was not what I wished to convey—but may I ask for his agreement that the important document issued by the Treasury and the Department for Education and Skills entitled "Policy review of children and young people: A discussion paper" requires a debate, and if it is in Government time, so be it?

Andrew Selous: I thank the right hon. Gentleman for his intervention. Were I the shadow Leader of the House, which I am not, I would have no hesitation in asking the Leader of the House to provide a debate in Government time on that important report. I will convey his request to the shadow Leader of the House so that she may raise it with the Leader of the House at business questions on Thursday. I am grateful to the right hon. Gentleman for raising that point. It is a valid one. As I say, these issues are so serious that we need to continue to focus on them to make the improvements that we all want.
	I commend the motion, and also my hon. Friend the Member for South-West Surrey, for the work that he has undertaken in this area.

Ivan Lewis: The subject of this debate should unite all parties. We can reflect with some pride on the advances that have been made, but frankly, we still have a long way to go, as the "Every Disabled Child Matters" campaign and the recent parliamentary hearings prove.
	We have had a good debate in which many important issues have been raised. I want to begin my speech by paying particular tribute to the work done in this House by my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) and my hon. Friends the Economic Secretary to the Treasury and the Member for Blackpool, North and Fleetwood (Mrs. Humble) in shining a long overdue light on the needs of disabled children and their families. I also pay tribute to the children's charities and carers' organisations and the many individual parents and professionals who have fought for the rights of disabled children over many decades. I recognise, too, that there are Members of all parties who are genuine in their commitment to improving the life chances of disabled children and their families.
	Children with disabilities are children first, with the same right to fulfil their potential, and to have a life free of poverty and full of hopes and dreams, as we seek for every child. Parents have the right to expect support that is personalised to their needs and the needs of their child, and a system that exists to provide solutions, not erect barriers. The mother of a disabled child in my constituency summed things up recently when she told me of her experiences: "Why do I have to shout before anyone will listen?" and "I am the expert when it comes to my son" are just two of the comments that struck an all-too-common chord.
	The needs of disabled children and their families represent the beginning of my journey to this House. At the age of 14, I began doing voluntary work for Outreach, a voluntary organisation that still serves my constituents by supporting children with learning disabilities on school holiday play schemes. I then started to support adults with learning disabilities on a leisure integration programme. That became my passion and my career choice. At the age of 19, I set up and ran a small voluntary organisation, Contact, a community care group offering children and adults leisure opportunities as well as providing respite to families. Contact still offers support to adults and their families in my constituency.
	Through that work, I learned much about myself, but more importantly I learned so much about the realities faced by disabled people of all ages and their families and carers. That taught me the values that are the foundations of my political beliefs, and it makes me proud to have the opportunity in Government to influence, and sometimes shape, change in that regard. I and my ministerial colleagues are strongly committed to policies such as "in Control", direct payments and individual budgets, which will transfer power and control in the delivery and shaping of services from organisations to those who use services and their families.
	So what are the values to which I refer? Every disabled child is an individual with distinct needs, emotions and potential. Every disabled child has a fundamental right to be included as part of their community and our society. I get angry when I hear some politicians and commentators deride inclusion as having failed and as being simply about political correctness, and when they talk only of those parents seeking special or segregated education, and when they talk about disabled children in a patronising, demeaning way.
	Of course our system is not yet as good as it needs to be in terms of specialist expertise, sensitivity and resources; the hon. Member for Buckingham (John Bercow) made that point. Attitudes, including among some educationalists, are not always as they should be.
	I accept that some parents still feel that special schools are the best available option. In my constituency, I am proud of Elms Bank which was one of the first special secondary schools to achieve specialist status and recently made it into the top 5 per cent. of schools for value added performance, including mainstream schools.
	I could also however introduce Members to many parents who have fought against the professionals and the system to demand a mainstream education for their children, and who could describe the thrill of their child's first day alongside their non-disabled brother or sister at the local school, or who have cried themselves to sleep because the local education system has come up with all sorts of reasons why their child has to be excluded from the mainstream system. Those parents deserve to be heard in this debate, and more generally.
	The hon. Member for Buckingham, who now has extremely important personal experience, made a fantastic speech which I could not disagree with a word of. He talked about the importance of trained support staff. Our debate should not be about being for or against inclusion; we should recognise that to make a reality of inclusion, which should be the norm for the vast majority of disabled children, we have to get to a situation in which specialist support staff are available to provide the necessary support.
	In the context of change, I remember those who vigorously opposed the closure of the long-stay mental handicap hospitals in the 1980s and 1990s. They said that "mentally handicapped" people could not possibly live in the community; that they needed looking after by nurses; that they somehow posed a risk to children. I wish that those people could see today adults with learning disabilities being supported in living in their own homes by organisations such as Outreach and Build, in my constituency. After 30 or 40 years of being locked away in institutions, they live ordinary lives as neighbours, friends and family members in our community. In my current role, and in the aftermath of Cornwall and Orchard Hill, I am determined to ensure that the remaining four hospitals are closed and the residents provided with the support that they deserve in the community.
	Change should of course be done properly, for the right reasons and with respect for the needs and preferences of children and their parents, but inclusion is right. Members should reflect on this: how many citizens opt for exclusion from society when given an authentic choice? We need to think about that when we make such policy decisions. Our long-term goal should be to maximise inclusion in education, health, leisure and work and all areas of public policy.
	I also want to share with Members my view of Scope's current campaign as it relates to the recent decision to restrict the growth of a disabled child in the United States of America. I am always reluctant to appear in any way critical of parents and the difficult decisions that they make about their children. That is particularly the case when, owing to a serious disability, the parent may feel genuinely unable to establish the view of the child or young person. However, I believe that every child has the right, irrespective of any disability, to grow into an adult physically, and with all the rights and opportunities available to every other citizen. Scope, in my view, is right to make a stand in this country on that issue.
	Over the years, much of my personal inspiration has come from examples of battling parents, grandparents and carers: people such as Lynne Elwell, who, following her many negative experiences of the system as the mother of the late Nicola, has created a national network called Partners in Policymaking. I urge Members in all parts of the House to find out more about that organisation. Parents and people with learning disabilities participate in training courses, leading to the status of a Partners graduate. Partners in Policymaking empowers parents and disabled people to build their confidence, knowledge and support systems, so that they can fight for their rights as partners, not as adversaries of professionals and the system. I say to my hon. Friend the Member for Blackpool, North and Fleetwood that, in many ways, the best advocates are parents who have themselves been through the system and can represent the interests of other parents. I believe very strongly in building such networks around the country.
	When I speak to Raymond, the late Nicola's father, I feel not only the acute pain of his loss, but his enduring anger at the failure of the system on so many occasions during her life. We should also consider people such as Geraldine Green, who is not only a full-time carer for her grandchildren but runs an enterprising local voluntary organisation called Hurdles, which offers a range of support for disabled children and their families in my constituency and that of my hon. Friend the Member for Bury, North (Mr. Chaytor). These individuals and, as the hon. Member for South-West Surrey (Mr. Hunt) said in his opening remarks, many others are the heroes whose vision and commitment have been born out of frustration—sometimes anger—at the failings of the system.
	I now turn to some of the contributions made by Members. The hon. Member for South-West Bedfordshire (Andrew Selous) talked about the importance of information sharing between agencies to ensure that people get a truly joined-up service. I share that view, but I ask him to reconsider his party's opposition to data sharing on the sometimes spurious ground of civil liberties. On physical restraint, I should also point out that Opposition Members cannot say that they are against targets imposed by central Government, and then ask us to direct every head teacher in every school in the country to do what, frankly, I believe should be regarded in most schools as best practice. The hon. Gentleman is wrong about initial teacher training, which has a significant focus on the requirement to be sensitive to special educational needs, but we can share more information with him on that issue at another time. As a distinguished member of the Work and Pensions Committee, the hon. Gentleman signed up to a report that said that the Government were on target to halve child poverty by 2010, but tonight he has signed up to a motion claiming that that will not be achieved.
	The hon. Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander)—that is a difficult one at this time of night—made an excellent speech. It was fair, balanced, credible and sensible. He made the important point that the interventions that we make in childhood and the early years do not affect the child only during that period of their life, but their whole life opportunities. He made several other important points.
	My hon. Friend the Member for Blackpool, North and Fleetwood was once the chair of a social services committee, as I was, and she made several very important points. Of course we have to grapple with the consequences of demographic change, which means that people thankfully live longer and have fuller lives, but their disabilities can also be more complex and more challenging. She was right to refer to the centrality of the transition from being a child to being a young adult, and the need—as we are now doing across Government—to have that as a standing item on the inter-ministerial group that looks at all matters to do with disabled people. She was also right to draw attention to the fact that key workers should be at the heart of a future system, in terms of guiding parents through all the complex issues.

Andrew Selous: Will the Minister give way?

Ivan Lewis: I am afraid that I have no time to give way to the hon. Gentleman.
	As I have said, the hon. Member for Buckingham made an excellent speech. He speaks with great authority, credibility and integrity on these matters and he does not seek to make cheap party political points. I could not disagree with one single element of the contribution that he made to the debate. I would gently say to him that we do now have a common assessment framework for children for the first time. It is being rolled out across the country and I hope that it will add value and make a difference. The hon. Gentleman mentioned children with autism, and our extension of the child and adolescent mental health services—CAMHS—teams across the country means that we now have more specialist professionals who have expertise in autism and who are able to make assessments at an early stages as part of the CAMHS system.
	My hon. Friend the Member for Stourbridge (Lynda Waltho) mentioned cuts being imposed by a Tory council in Dudley on transport for disabled children and voluntary youth services. I urge Opposition Front Benchers to intervene with their colleagues who run that local authority.
	In nearly 10 years, this Government have done a lot that has had a positive impact on the daily lives of disabled children, their parents and families. I want to pay particular tribute to the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Stirling (Mrs. McGuire), who has done a tremendous job in her capacity as the Minister with responsibility for disabled people.
	We have doubled the NHS budget since 1997 and will have almost tripled it by 2008. We have increased education funding per pupil since 1997 from £3,050 to £4,490. We have identified as one of our nation's top priorities the elimination of child poverty. We have funded the early support programme to improve the quality of co-ordination for young disabled children. We have published a range of supporting guidance on transition, complex disability, palliative care and autism. We have significantly increased funding for short breaks through the carer's grant, extended the mobility element of the DLA to children from the age of three, and doubled the disabled child and carer's premium since 1997. We have awarded £27 million for three years, starting in 2006-07, to support children's hospices and the provision of palliative care. We have developed Sure Start and new children's centres in every community. We have established the Office for Disability Issues. We are currently considering as a priority the needs of disabled children and their families as part of the comprehensive spending review process, and I will soon announce a new deal for carers, including specific funding for emergency respite care.
	Every disabled child matters. All parties have a duty to seek improvements that will achieve a truly joined-up system, for children and for those at the crucial transition stage between childhood and adulthood.

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	 Question, That the Question be now put,  put and agreed to.
	 Question put accordingly, That the original words stand part of the Question:—
	 The House proceeded to a Division.

Mr. Deputy Speaker: I ask the Serjeant at Arms to investigate the delay in the No Lobby.

The House having divided: Ayes 231, Noes 288.

Question accordingly negatived.
	 Question, That the proposed words be there added,  put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr. Deputy Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House welcomes the fact that this Government acknowledged the challenges faced by disabled children and their families by publishing a report in 2005, Improving the Life Chances of Disabled People; welcomes the establishment of an Office for Disability Issues to improve coordination of disability policy across Whitehall and provide a forum for the voice of disabled people; recognises that the Government committed itself to improve outcomes for all children and young people through its change programme — Every Child Matters - which is driving change in local areas through the establishment of Children's Trusts; commends the Government in its specific focus on disabled children in the disabled children's standard of the Children's National Service Framework and the Special Educational Needs strategy, Removing Barriers to Achievement; acknowledges the Government's close working with stakeholders from the disabled children sector in developing its work programme; notes the Government's investment in support services for families with disabled children through its funding of the Family Fund and the Contact a Family national help line; commends the success of the Government's Early Support Programme for young disabled children; further commends the introduction of direct payments for families with disabled children and disabled young people, which increase choice and control and empowers those families; and congratulates the Government's commitment to further improving services for disabled children through the disability strand of the Children and Young People Policy Review.

DELEGATED LEGISLATION

Mr. Deputy Speaker: With the leave of the House, I shall put together the Questions on motions 3 to 8.
	 Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Delegated Legislation Committees),

Consumer Protection

That the draft Compensation (Exemptions) Order 2006, which was laid before this House on 28th November, be approved.

Companies

That the draft Uncertificated Securities (Amendment) Regulations 2006, which were laid before this House on 18th December, be approved.

Financial Services and Markets

That the Financial Services and Markets Act 2000(Regulated Activities) (Amendment No. 3) Order 2006 (S.I., 2006, No. 3384), dated 18th December 2006, a copy of which was laid before this House on 18th December, be approved.
	That the draft Financial Services and Markets Act 2000 (Exemption) (Amendment) Order 2006, which was laid before this House on 18th December, be approved.
	That the draft Financial Services and Markets Act 2000 (Markets in Financial Instruments) Regulations 2006, which were laid before this House on 18th December, be approved.

Northern Ireland

That the draft Waste (Amendment) (Northern Ireland) Order 2007, which was laid before this House on 18th December, be approved.— [Mr. Heppell.]
	 Question agreed to.

School Admissions Code

Ordered,
	That the School Admissions Code 2007, dated 8th January, be referred to a Delegated Legislation Committee.— [Mr. Heppell.]

FOOTBALL (GAMBLING COMPANIES)

Motion made, and Question proposed, That this House do now adjourn. —[Mr. Heppell.]

Mr. Deputy Speaker: Before I call the hon. Member for Paisley and Renfrewshire, North (Jim Sheridan), I ask those hon. Members who are not staying for the debate please to leave quickly and quietly.

Jim Sheridan: I am extremely grateful to Mr. Speaker for granting me this Adjournment debate, in which I want to call for a full review of the relationship between the football leagues and, in fact, all sports events and the betting operators offering sporting bets on those events.
	As chair of the all-party Scottish football group, I am particularly concerned with the health of clubs in the Scottish Football League and, indeed, the Scottish premier league. Betting operators are taking what I can only describe as an opportunistic and parasitic approach to UK football. They are seeking to exploit to their maximum advantage the uncertainty created in the UK by some European Court judgments. While the game in the UK, particularly in the lower leagues, suffers severe financial hardship, betting operators are creating ever more profitable businesses and returning little to the sports that they use.
	That has not always been the case. Betting businesses and the football industry enjoyed a clear and settled relationship for well over 40 years. In 1959, the leagues obtained a judgment in the High Court that said clearly and unambiguously that the leagues were entitled to be paid for the use of their fixtures by pools betting companies. Football had established a copyright under UK law. The two industries worked well together in a clear legal framework. Members will recall that until the advent of pay-TV in the late 1980s and early 1990s, betting revenues were the single biggest commercial income for football.

James McGovern: I am not a gambling man—in fact, I could not write out a betting slip—but, like many of my constituents, I believed that when someone placed a bet on a football match, some contribution went to football clubs. Does my hon. Friend agree that many of his constituents, like my constituents, will be unaware of the fact that, when they place a bet, none of that money goes to help football clubs throughout the UK?

Jim Sheridan: I thank my hon. Friend for that helpful intervention. He is absolutely right. I would hazard a guess that most people who bet in betting shops throughout the UK, on Saturdays or midweek, would expect that some of the money that they are investing would go to the sport of football that they are placing the bet on. There is a need to educate people that the money that they invest does not go to the sports that they think that they are investing in.
	The contribution of pools money to the refurbishment of all-seating stadiums was vital. However, the clear legal relationship has become muddled by the combined effect of the European database directive—which was subsequently translated into UK law by regulations—and, most importantly, what seemed odd and unexpected judgments by the European Court of Justice, in complete opposition to the judgment of our national courts. After the 1959 ruling, the leagues managed to build healthy developing businesses across the world, licensing their copyright to betting businesses. However, they were met by resolute opposition in Europe from state sports betting monopolies, which simply did not want to have to pay leagues in the UK for the use of their events. Members will know that we pretty much stand alone in the EU with our market approach to sports betting. Other nations adopt a view that betting can be run only by state operators—a view that I would question and which the UK quite rightly resolutely refused to adopt in the Gambling Act 2005.
	The leagues brought actions against state operators in Sweden, Finland and Greece under the new database directive, which was supposed to enable European business to benefit from the global increase in the development of commercial databases. To the considerable surprise of the European Commission, author of the database directive, the European Court of Justice judgment went against the leagues and agreed with the arguments put by member states openly interested in protecting their own state betting operators. It is of some regret that the UK Government did not deem it correct to argue for their own football leagues against the combined strength of some 50 EU member state lawyers.
	To add insult to that injury, UK betting businesses accepted that judgment as their cue to claim that they do not have to pay football, or indeed any other sport, for the use of their products. Those betting businesses say that their obligation under UK law has been swept away. Worse still, at that very time, those same companies have been busily expanding their football and general sporting betting businesses. Surely that was never the Government's intention and is not right.
	Hon. Members will know that there is a similar background to another long-running issue: the financial health of horse racing, following a similar European Court of Justice judgment, which was delivered on the same day as the football cases judgment. There is a view that if the football cases had not arisen at the same time, the horse racing case would have followed the UK national court's ruling, and things would have gone the way of racing, and not of the betting businesses. Whatever the truth of that—and we will never know—the way forward for racing was clarified by the Minister in December. The levy has been extended, which I welcome, as do those involved in other sports.
	The Minister's actions suggest that he agrees with the principle that betting businesses should contribute a fair return to the sports on which they offer bets. He has been advised that that is right by the independent European sport review, which he himself commissioned. He is rightly championing its findings in Europe, but I ask that he state for the record that he agrees with the principle that betting businesses should pay a fair return to sports.

Joan Walley: I thank my hon. Friend for securing this important debate. The subject is equally important to lower-league clubs in England and the Scottish football league. Does he agree that if anyone can find a solution, it is this Minister for Sport? Is it not vital to stress to the Minister that the Department for Culture, Media and Sport, which has responsibility for both betting and football, must respond to the suggestions made by my hon. Friend?

Jim Sheridan: I thank my hon. Friend for that contribution. The problem is certainly not just a Scottish football issue, but a UK football issue. She has worked hard on behalf of Stoke City to try to get a resolution to the problem.

Anne Moffat: I, too, thank my hon. Friend for securing the debate. Does he agree that the issue affects not just football, but all sporting events? For example, in my constituency, golf plays a major role, and the problem may hamper what people are trying to do there.

Jim Sheridan: My hon. Friend is absolutely right that golf is a big issue. Certainly, betting businesses make vast amounts of money from people who bet on golf tournaments, but the money does not go back in at grass-roots level as it should, so that we can encourage people who wish to play golf. She is absolutely right to mention that.
	The next question is how we achieve a workable solution. The Minister has rightly called for a debate on issues arising from his announcement on the permanent extension of the horse racing levy. I will, of course, follow the matter with great interest. It is clear that adopting an equivalent statutory levy system is not a route that the Government can take to address the wrong for football and other sports. However, the Minister is known for his tenacity in finding a way to achieve what is deemed to be right. Does he not agree that there should be an open review, exploring the relationship between all sports events and the betting operators who use those events as their raw material?
	We are talking about a national issue, and it is for us to deal with it in Parliament. Other EU member states have addressed the relationship and have gone one way or another; indeed, some have criminalised sports betting, but Britain has taken a different route. We all believed that there was a clear rights-based relationship between sport and betting, and that was the foundation for the original abolition of the horse racing levy. However, things are obviously not clear at all, and we need to recover legal certainty. As I have said, however, there is an international dimension. I firmly believe that if the UK addresses the issue first, it will enable the Minister to advocate the UK view on sports betting to other nations with even greater authority. In the long term, that will benefit both sport and betting businesses in this country.
	I have dealt with the long-term situation and the principle that is at stake, but there are serious, pressing financial consequences for British clubs today. The league and the clubs face serious funding problems while UK betting operators take advantage of the situation. Scottish football's betting operator income has been reduced by 60 per cent. since the 2003-04 season. It is unacceptable that the Government should have allowed that to happen, as the development of grassroots football in the UK has been dealt another damaging blow. I have heard the spurious argument that because the highest level of football in England is successful at selling TV rights, we should not concern ourselves with those issues and we should release the betting companies from their obligation. I dread to think what state we would be in if we took that approach to all the issues that we face. It is a smokescreen put up by betting businesses to protect their profits.
	The sports betting industry does not accept that it is under any obligation to provide a fair return to the sport, or that it should do all that it can to protect football's integrity from unscrupulous betting practices. Those betting businesses appear to be saying that they cannot be expected to provide that protection, even if they agree privately that they should do so, unless they are under an unambiguous legal obligation. That is why I am seeking a fundamental and open review of the relationship between the betting companies, football and, indeed, other sports. In conclusion, I thank the Minister for his outstanding contribution to developing sport in the UK and for his tireless work to create a world-leading framework for sports betting. It is now time to bring the two halves together to create clarity in the interests of both business sectors, and it is within his power to do so.

Richard Caborn: First, I congratulate my hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) on his success in securing a debate on an interesting subject. Both the Secretary of State and I are aware, from correspondence with the Football Association and Football DataCo, that it is an issue of great concern to football clubs, both in England and north of the border, so I am grateful to my hon. Friend for giving the House an opportunity to discuss it.
	As my hon. Friend explained, football's main concerns arise from a ruling by the European Court of Justice in 2005 that sports bodies cannot charge betting operators monopoly prices for data such as match fixture lists. As a result, Football DataCo, which passes its proceeds on to the Scottish and English leagues, can no longer sell data to pools companies and bookmakers. I accept that the directive has led to a loss of revenue for football, but that should not be exaggerated. To make progress and to help the Scottish clubs that have been particularly affected, we must secure more voluntary agreements between football and the betting industry, and urge football's governing bodies to look at the way in which any specific shortfalls can be met by other revenue streams. I shall address the specific points made by my hon. Friend to demonstrate why we must do so.
	First, I wish to make it clear that a good case has not yet been made for the UK to reopen the issue of the database directive, and that the Government have no plans to do so. The directive was introduced with the reasonable intention of protecting the investment of database providers who have not just created data, but made a new and valuable product with that information. In 2005, the European Court of Justice clarified the distinction between two types of database—the protected and the non-protected—and it became clear that the database held by Football DataCo was not protected.
	It is true that the decision of the European Court of Justice has meant that some sporting bodies are looking for alternative sources of funding as they are unable to license the data from their fixture lists, but the decision has also clarified what the law means. To re-open it now would cause a great deal of uncertainty for the database industries, at exactly the time when, finally, they have a clear understanding of the level of protection accorded to their databases. In any case, as my hon. Friend knows, any change would have to be based on a consensus between the other EU member states, which would be difficult to achieve, as I think he would accept.
	I should be clear that the Government have no intention of creating a new intellectual property right to cover sport databases in order to give them a monopoly over the use of simple data such as fixture lists. Discussions with the Patent Office have confirmed that there are no grounds to amend our database regulations or to make special intellectual property rights in this case. I firmly believe that agreements between the sport and the betting industry are the right way forward.
	That is why in February last year I brought together Ladbrokes and the premier league. I am pleased to say that the result of this meeting was that Ladbrokes, William Hill, Coral and a number of other bookmakers agreed to a five-year funding deal for football, through continuing voluntary payments for the use of data via Football DataCo. This year, their contributions amounted to just over £3 million, and I am grateful to Football DataCo for the excellent job it is doing in distributing this income to football clubs north and south of the border.
	In particular, I am grateful for the contributions made to smaller clubs. As my hon. Friend knows, last year, over £500,000 of bookmakers' contributions went to Scottish football clubs, via Football DataCo. I realise that the company wants to increase that amount and I have some sympathy with that aim. That is why I give my full support and encouragement to continuing discussions with bookmakers who are not currently making voluntary contributions, with the aim of increasing the total income from betting to football.
	The shortfall, once voluntary agreements have been factored in, is a little over £2 million. Although this may be small change in the overall scheme of things—the premier league's recent agreement on media and TV rights packages for the three years from the start of the 2007-08 season is £2.7 billion—it highlights what I believe is a golden opportunity for all involved in the game to think again about how grassroots football is supported, in the light of the wider debate triggered by the publication of the independent European sport review, to which my hon. Friend rightly referred.
	In the short term, I am confident that, through further voluntary agreements and perhaps income from other sources, the effects of the loss of revenue can be minimised. I would encourage those involved in the game to explore longer-term and sustainable means of ensuring that the grassroots and smaller clubs on whom the future of the game depends are financially stable and are rewarded for the vital contribution that they make. The question for football is how it ensures that its unprecedented commercial success in recent years can be used to ensure its long-term success and stability through supporting the grassroots on which those depend.
	It is understandable why a comparison is sometimes made between the situation in horse racing—this was central to my hon. Friend's argument—where we have recently announced the retention of the horse race betting levy on bookmakers, and other sports, where there is no such levy. Let me explain why there is no question of the Government establishing for football or any other sport a levy analogous to the horse race levy. First, horse racing still makes up about 50 to 60 per cent. of betting business in the UK. Although betting on football is increasing, it is not yet even close to that level. The horse race betting levy acknowledges the special relationship between horse racing and betting, and was established back in the 1960s on that basis.
	Secondly, any new levy or sports betting right is likely to constitute illegal state aid from the point of view of the European Commission. Policy would have to be implemented at EU level to facilitate sports levies across all member states, and it would then be up to national Governments to implement them. The Government ultimately aim to replace the horse race betting levy with a more modern, sustainable and commercial arrangement between the bookmakers and horse racing. We do not perceive the levy as a model for the future funding of any other sport.
	To sum up, I believe that, although that the effect of the European Court of Justice ruling on databases has had some effect on the financial contribution of gambling companies to football, it needs to be put into perspective in terms of the amounts and the directive's wider benefits. There is no convincing case to show that it has had a significantly negative effect on the overall financial position of the sport. I am confident that, given the determination and commitment of the football authorities, any losses can be recouped through further voluntary agreements between the industries. The Government's position is clear—it is up to the bookmakers and the football authorities, as two independent commercial interests, to come to further financial agreements. I will do all in my power to facilitate that and I encourage those bodies to come together and find a solution.
	I believe that the actions that we have taken so far and future agreements between the two main parties will resolve the matter. If we can do that, football and, indeed, other sports, will be enhanced.
	 Question put and agreed to.
	 Adjourned accordingly at nineteen minutes to Eleven o'clock.